At the coalface and the cutting edge: general practitioners’ accounts of the rewards of engaging with HIV medicine

PubMed Central

2013-01-01

Background HIV has become a chronic manageable infection in the developed world, and early and lifelong treatment has the potential to significantly reduce transmission rates in the community. A skilled and motivated HIV medical workforce will be required to achieve these health management and prevention outcomes, but concerns have been noted in a number of settings about the challenges of recruiting a new generation of clinicians to HIV medicine. Methods As part of a larger qualitative study of the HIV general practice workforce in Australia, in-depth interviews were conducted with 31 general practitioners accredited to prescribe HIV medications in community settings. A thematic analysis was conducted of the de-identified transcripts, and this paper describes and interprets accounts of the rewards of pursuing and sustaining an engagement with HIV medicine in general practice settings. Results The rewards of initially becoming involved in providing care to people living with HIV were described as interest and inspiration, community calling and right place, right time. The rewards which then supported and sustained that engagement over time were described as challenge and change, making a difference and enhanced professional identity. Participants viewed the role of primary care doctor with special expertise in HIV as occupying an ideal interface between the ‘coalface’ and the ‘cutting edge’, and offering a unique opportunity for general practitioners to feel intimately connected to both community needs and scientific change. Conclusions Approaches to recruiting and retaining the HIV medical workforce should build upon the intellectual and social rewards of this work, as well as the sense of professional belonging and connection which is imbued between both doctors and patients and across the global and national networks of HIV clinicians. Insights regarding the rewards of engaging with HIV medicine may also be useful in enhancing the prospect of general practice as a career, and strengthening retention and job satisfaction among the existing general practice workforce. PMID:23517462

Annotated Bibliography for Adult Educators in Institutional Settings.

ERIC Educational Resources Information Center

Elwyn Inst., PA.

This annotated bibliography of instructional materials for adult educators in institutional settings lists materials available in fourteen areas: basic skills, citizenship education, community services, consumer education, health and safety, mathematics, meal planning, money management, personal information/general life skills, pre-employment…

Evaluating and Evolving Metadata in Multiple Dialects

NASA Technical Reports Server (NTRS)

Kozimore, John; Habermann, Ted; Gordon, Sean; Powers, Lindsay

2016-01-01

Despite many long-term homogenization efforts, communities continue to develop focused metadata standards along with related recommendations and (typically) XML representations (aka dialects) for sharing metadata content. Different representations easily become obstacles to sharing information because each representation generally requires a set of tools and skills that are designed, built, and maintained specifically for that representation. In contrast, community recommendations are generally described, at least initially, at a more conceptual level and are more easily shared. For example, most communities agree that dataset titles should be included in metadata records although they write the titles in different ways.

Toward Generalization of Appropriate Leisure and Social Behavior in Severely Handicapped Youth: Pinball Machine Use.

ERIC Educational Resources Information Center

Hill, Janet W.; And Others

1982-01-01

The study demonstrated the acquisition and generalization into community settings of a chronologically age-appropriate leisure skill with three severely and profoundly mentally retarded adolescents. Results indicated that participants could acquire and generalize use of an electronic pinball machine leisure skill effectively and learn to exhibit…

People with an Intellectual Disability Living in an Intentional Community

ERIC Educational Resources Information Center

Randell, M.; Cumella, S.

2009-01-01

Background: Hospital closure programmes in England have generally sought to attain a fulfilling life for people with an intellectual disability by locating them in domestic-style housing in urban settings. Few have been placed in intentional or "village" communities. Yet comparative studies of different housing types have found that…

Including Students with Severe Disabilities in General Education Settings.

ERIC Educational Resources Information Center

Wisniewski, Lech; Alper, Sandra

1994-01-01

This paper presents five systematic phases for bringing about successful regular education inclusion of students with severe disabilities. Phases include develop networks within the community, assess school and community resources, review strategies for integration, install strategies that lead to integration, and develop a system of feedback and…

A Model for Teaching Basic Skills in a Community College Setting.

ERIC Educational Resources Information Center

Brantley, Jerry; And Others

The Basic Skills Program described in this report was developed by Macomb County Community College (MCCC) as a semester-long pre-vocational program for Comprehensive Employment and Training Act (CETA) students. Following introductory material, Part I presents a general review of postsecondary developmental education programs for…

Effects of community-based, videotape, and flash card instruction of community-referenced sight words on students with mental retardation.

PubMed Central

Cuvo, A J; Klatt, K P

1992-01-01

Community-referenced sight words and phrases were taught to adolescents with mild and moderate mental retardation using three instructional methods in two locations. Words were presented on flash cards in a school setting, on videotape recordings in a school setting, and on naturally occurring signs in the community. During each session, participants were taught one third of the words in each of these conditions and were then tested at the community sites. A constant prompt delay procedure was used to promote stimulus control to the experimenter's cue initially and then to transfer control to the textual stimuli used for training. A multiple baseline across participants design was employed. Results showed rapid acquisition of the community-referenced sight words in all three training conditions and generalization from the flash card and videotape conditions to the community sites. PMID:1378827

Associations between the social organization of communities and psychiatric disorders in rural Asia.

PubMed

Axinn, William G; Ghimire, Dirgha J; Williams, Nathalie E; Scott, Kate M

2015-10-01

We provide rare evidence of factors producing psychiatric variation in a general population sample from rural South Asia. The setting is particularly useful for demonstrating that variations in the social organization of communities, often difficult to observe in rich countries, are associated with important variations in mental health. Clinically validated survey measures are used to document variation in psychiatric disorders among 401 adults. This sample is chosen from a systematic sample of the general population of rural Nepal, in a community-level-controlled comparison design. Multilevel logistic regression is used to estimate multivariate models of the association between community-level nonfamily social organization and individual-level psychiatric disorders. Schools, markets, health services and social support groups each substantially reduce the odds of depression, post-traumatic stress disorder (PTSD), intermittent explosive disorder and anxiety disorders. Associations between schools, health services and social support groups and depression are statistically significant and independent of each other. The association between access to markets and PTSD is statistically significant and independent of other social organization and support groups. Community integration of some nonfamily social organizations promotes mental health in ways that may go unobserved in settings with many such organizations. More research on the mechanisms producing these associations is likely to reveal potential avenues for public policy and programs to improve mental health in the general population.

Associations between the Social Organization of Communities and Psychiatric Disorders in Rural Asia

PubMed Central

Axinn, William G.; Ghimire, Dirgha J.; Williams, Nathalie E.; Scott, Kate M.

2015-01-01

Purpose We provide rare evidence of factors producing psychiatric variation in a general population sample from rural South Asia. The setting is particularly useful for demonstrating that variations in the social organization of communities, often difficult to observe in rich countries, are associated with important variations in mental health. Methods Clinically validated survey measures are used to document variation in psychiatric disorders among 401 adults. This sample is chosen from a systematic sample of the general population of rural Nepal, in a community-level controlled comparison design. Multilevel logistic regression is used to estimate multivariate models of the association between community-level nonfamily social organization and individual-level psychiatric disorders. Results Schools, markets, health services and social support groups each substantially reduce the odds of depression, post-traumatic stress disorder (PTSD), intermittent explosive disorder (IED) and anxiety disorders. Associations between schools, health services and social support groups and depression are statistically significant and independent of each other. The association between access to markets and PTSD is statistically significant and independent of other social organization and support groups. Conclusions Community integration of some nonfamily social organizations promotes mental health in ways that may go unobserved in settings with many such organizations. More research on the mechanisms producing these associations is likely to reveal potential avenues for public policy and programs to improve mental health in the general population. PMID:25796491

Meeting the needs of vulnerable patients: The need for team working across general practice and community nursing services

PubMed Central

While, Alison E

2014-01-01

General practitioners and district nurses have a long history of providing care outside the hospital setting. With health care increasingly moving out of the hospital setting, there are more opportunities for general practitioners and district nurses to work together to meet the health needs of the local population. However, the reduction in qualified specialist practitioner district nurses over the last decade is concerning. The need for an effective district nursing service has been recognised by the Department of Health in their own model – the nature of district nursing work, often over a long period, enables relationships to develop with the patient, family and informal carers as a basis for anticipatory care to manage long-term conditions. Communication and understanding of the role are central to enhance effective working between general practitioners and district nurses, which can be fostered by engagement in community-oriented integrated care and case management. PMID:25949736

Impact of alcohol harm reduction strategies in community sports clubs: pilot evaluation of the Good Sports program.

PubMed

Rowland, Bosco; Allen, Felicity; Toumbourou, John W

2012-05-01

Approximately 4.5 million Australians are involved in community sports clubs. A high level of alcohol consumption tends to be commonplace in this setting. The only program of its type in the world, the Good Sports program was designed to reduce harmful alcohol consumption in these Australian community sports clubs. The program offers a staged accreditation process to encourage the implementation of alcohol harm-reduction strategies. We conducted a postintervention adoption study to evaluate whether community sports club accreditation through the Good Sports program was associated with lower rates of alcohol consumption. We examined alcohol consumption rates in 113 clubs (N = 1,968 participants) and compared these to consumption rates in the general community. We hypothesized that members of clubs with more advanced implementation of the Good Sports accreditation program (Stage Two) would consume less alcohol than those with less advanced implementation (Stage One). Multilevel modeling (MLM) indicated that on days when teams competed, Stage Two club members consumed 19% less alcohol than Stage One club members. MLM also indicated that the length of time a club had been in the Good Sports program was associated with reduced rates of weekly drinking that exceeded Australian short-term risky drinking guidelines. However consumption rates for all clubs were still higher than the general community. Higher accreditation stage also predicted reduced long-term risky drinking by club members. Our findings suggest that community sports clubs show evidence of higher levels of alcohol consumption and higher rates of risky consumption than the general community. Implementation of the Good Sports accreditation strategy was associated with lower alcohol consumption in these settings.

Will Virtue Ethics Improve Ethical Conduct in Multicultural Settings and Interactions?

ERIC Educational Resources Information Center

Vasquez, Melba J. T.

1996-01-01

Responds to Meara et al.'s (1996) article concerning virtue ethics on the issue of applying ethical standards as a means of responding sensitively to minority groups. Questions the definition of community and reliance on community values as a guiding principle, and suggests that psychologists generally choose theoretical orientations based on…

From the bush to the big smoke--development of a hybrid urban community based medical education program in the Northern Territory, Australia.

PubMed

Morgan, S; Smedts, A; Campbell, N; Sager, R; Lowe, M; Strasser, S

2009-01-01

The Northern Territory (NT) of Australia is a unique setting for training medical students. This learning environment is characterised by Aboriginal health and an emphasis on rural and remote primary care practice. For over a decade the NT Clinical School (NTCS) of Flinders University has been teaching undergraduate medical students in the NT. Community based medical education (CBME) has been demonstrated to be an effective method of learning medicine, particularly in rural settings. As a result, it is rapidly gaining popularity in Australia and other countries. The NTCS adopted this model some years ago with the implementation of its Rural Clinical School; however, urban models of CBME are much less well developed than those in rural areas. There is considerable pressure to better incorporate CBME into medical student teaching environment, particularly because of the projected massive increase in student numbers over the next few years. To date, the community setting of urban Darwin, the NT capital city, has not been well utilised for medical student training. In 2008, the NTCS enrolled its first cohort of students in a new hybrid CBME program based in urban Darwin. This report describes the process and challenges involved in development of the program, including justification for a hybrid model and the adaptation of a rural model to an urban setting. Relationships were established and formalised with key partners and stakeholders, including GPs and general practices, Aboriginal medical services, community based healthcare providers and other general practice and community organisations. Other significant issues included curriculum development and review, development of learning materials and the establishment of robust evaluation methods. Development of the CBME model in Darwin posed a number of key challenges. Although the experience of past rural programs was useful, a number of distinct differences were evident in the urban setting. Change leadership and inter-professional collaboration were key strengths in the implementation and ongoing evaluation of the program. The program will provide important information about medical student training in urban community settings, and help inform other clinical schools considering the adoption of similar models.

Beginning community engagement at a busy biomedical research programme: Experiences from the KEMRI CGMRC-Wellcome Trust Research Programme, Kilifi, Kenya

PubMed Central

Marsh, Vicki; Kamuya, Dorcas; Rowa, Yvonne; Gikonyo, Caroline; Molyneux, Sassy

2008-01-01

There is wide acknowledgement of the need for community engagement in biomedical research, particularly in international settings. Recent debates have described theoretical approaches to identifying situations where this is most critical and potential mechanisms to achieve it. However, there is relatively little published experience of community engagement in practice. A major component of the Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme is centred on Kilifi District General Hospital and surrounding community of 240,000 local residents. Documented community perceptions of the research centre are generally positive, but many indicate a low understanding of research and therapeutic misconceptions of its activities. As in other settings, these misunderstandings have contributed to concerns and rumours, and potentially undermine ethical aspects of research and local trust in the institution. Through a series of consultative activities, a community engagement strategy has been developed in Kilifi to strengthen mutual understanding between community members and the Centre. One important component is the establishment of a representative local resident network in different geographic locations commonly involved in research, to supplement existing communication channels. Early implementation of the strategy has provided new and diverse opportunities for dialogue, interaction and partnership building. Through the complex social interactions inherent in the community engagement strategy, the centre aims to build context specific ethical relations with local residents and to strengthen understanding of how ethical principles can be applied in practice. Evaluations over time will assess the effectiveness and sustainability of these strategies, provide generalisable information for similar research settings, and contribute to debates on the universality of ethical principles for research. This paper aims to summarise the rationale for community engagement in research, drawing on published literature and local findings, to outline the process of community engagement in Kilifi and to describe issues emerging from its development and early implementation. PMID:18375028

Yes! There are resilient generalizations (or "laws") in ecology.

PubMed

Linquist, Stefan; Gregory, T Ryan; Elliott, Tyler A; Saylor, Brent; Kremer, Stefan C; Cottenie, Karl

2016-06-01

ABSTRACT It is often argued that ecological communities admit of no useful generalizations or "laws" because these systems are especially prone to contingent historical events. Detractors respond that this argument assumes an overly stringent definition of laws of nature. Under a more relaxed conception, it is argued that ecological laws emerge at the level of communities and elsewhere. A brief review of this debate reveals an issue with deep philosophical roots that is unlikely to be resolved by a better understanding of generalizations in ecology. We therefore propose a strategy for transforming the conceptual question about the nature of ecological laws into a set of empirically tractable hypotheses about the relative re- silience of ecological generalizations across three dimensions: taxonomy, habitat type, and scale. These hypotheses are tested using a survey of 240 meta-analyses in ecology. Our central finding is that generalizations in community ecology are just as prevalent and as resilient as those in population or ecosystem ecology. These findings should help to establish community ecology as a generality-seeking science as opposed to a science of case studies. It also supports the capacity for ecologists, working at any of the three levels, to inform matters of public policy.

Sexuality in a Community Based Sample of Adults with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Gilmour, Laura; Schalomon, P. Melike; Smith, Veronica

2012-01-01

Few studies have examined the sexual attitudes and behaviours of individuals with high functioning autism spectrum disorders (ASDs) living in community settings. A total of 82 (55 female and 17 male) adults with autism were contrasted with 282 members of the general population on their responses to an online survey of sexual knowledge and…

The Expanding Role of Community-Based Organizations: Implications for Vocational Education. Occasional Paper No. 90.

ERIC Educational Resources Information Center

Poulard, Othello W.

Community-based organizations (CBOs) are neighborhood-based groups committed to providing human services to poor and minority individuals. The charge that government ineptness generates a need for CBOs is supported by examination of the federal government's operation of the general revenue sharing program. A project set up by CBOs collected data…

Provision of community-wide benefits in public health intervention research: the experience of investigators conducting research in the community setting in South Asia.

PubMed

Taylor, Holly A; Merritt, Maria W

2012-12-01

This article describes the types of community-wide benefits provided by investigators conducting public health research in South Asia as well as their self-reported reasons for providing such benefits. We conducted 52 in-depth interviews to explore how public health investigators in low-resource settings make decisions about the delivery of ancillary care to research subjects. In 39 of the interviews respondents described providing benefits to members of the community in which they conducted their study. We returned to our narrative dataset to find answers to two questions: What types of community-wide benefits do researchers provide when conducting public health intervention studies in the community setting, and what reasons do researchers give when asked why they provided community-wide benefits? The types of community-wide benefits delivered were directed to the health and well-being of the population. The most common types of benefits delivered were the facilitation of access to health care for individuals in acute medical need and emergency response to natural disasters. Respondents' self-reported reasons when asked why they provided such benefits fell into 2 general categories: intrinsic importance and instrumental importance. © 2012 Blackwell Publishing Ltd.

Transition of Youth and Young Adults with Emotional or Behavioral Difficulties: An Evidence-Supported Handbook

ERIC Educational Resources Information Center

Clark, Hewitt B., Ed.; Unruh, Deanne K., Ed.

2009-01-01

This comprehensive professional handbook will help transition specialists, general and special educators, school psychologists, and administrators support youth and young adults in setting goals and achieving positive outcomes across employment, education, and community settings. Through up-to-date research and in-depth analyses of five successful…

The Education of Juveniles in Detention: Policy Considerations and Infrastructure Development

ERIC Educational Resources Information Center

Geib, Catherine Foley; Chapman, John F.; D'Amaddio, Amy H.; Grigorenko, Elena L.

2011-01-01

This article presents a discussion of the state of affairs pertaining to educating juvenile justice-involved youth. It summarizes general observations regarding the schooling of juveniles in pre-trial and post-trial incarceration settings, as well as, juveniles on probation or in community settings. The article selectively presents relevant…

Evaluation of a train-the-trainer program for stable coronary artery disease management in community settings: A pilot study.

PubMed

Shen, Zhiyun; Jiang, Changying; Chen, Liqun

2018-02-01

To evaluate the feasibility and effectiveness of conducting a train-the-trainer (TTT) program for stable coronary artery disease (SCAD) management in community settings. The study involved two steps: (1) tutors trained community nurses as trainers and (2) the community nurses trained patients. 51 community nurses attended a 2-day TTT program and completed questionnaires assessing knowledge, self-efficacy, and satisfaction. By a feasibility and non-randomized control study, 120 SCAD patients were assigned either to intervention group (which received interventions from trained nurses) or control group (which received routine management). Pre- and post-intervention, patients' self-management behaviors and satisfaction were assessed to determine the program's overall impact. Community nurses' knowledge and self-efficacy improved (P<0.001), as did intervention group patients' self-management behaviors (P<0.001). The satisfaction of community nurses and patients was all very positive after training. The TTT program for SCAD management in community settings in China was generally feasible and effective, but many obstacles remain including patients' noncompliance, nurses' busy work schedules, and lack of policy supports. Finding ways to enhance the motivation of community nurses and patients with SCAD are important in implementing community-based TTT programs for SCAD management; further multicenter and randomized control trials are needed. Copyright © 2017 Elsevier B.V. All rights reserved.

Sentinel monitoring of general community health during the 1998 World Football Cup.

PubMed

Hanslik, T; Espinoza, P; Boelle, P Y; Cantin-Bertaux, D; Gallichon, B; Quendez, S; Aïm, J L; Retel, O; Ballereau, M; Gorodetzky, N; Flahault, A

2001-04-01

Present knowledge of the consequences of mass gatherings for the health of the community is scant. Our objective was to determine the impact of the 1998 World Football Cup on general community health. We set up an electronic sentinel disease surveillance, before, during and after the World Football Cup tournament held in France from June 10 to July 12, 1998. Medical activity, and the daily number of cases of communicable, environmental, and societal diseases relating to mass gatherings were surveyed. The incidence of the pathologies surveyed in real time during and after the World Cup versus the pre-Cup reference period was the main outcome measure. Five sentinel networks participated, comprising 553 general practitioners, 60 hospital adult emergency departments, 19 private emergency community services, 4 community health centres, and the medical centre of the Paris airports. Throughout the 66-day study period, physicians reported 558,829 medical encounters via 21,532 connections to the computer. Compared to the reference period, the level of medical activity reflected by the pathological items surveyed remained stable during the study period. The 1998 World Football Cup had no epidemiological impact on general community health, as observed by sentinel networks located downstream of the specific health services provided by the French authorities to ensure high standards of safety.

Stimulus Generalization of Parenting Skills during Parent-Child Interaction Therapy

ERIC Educational Resources Information Center

Naik-Polan, Anjali T.; Budd, Karen S.

2008-01-01

This study investigated the generalization of parenting skills to the home from PCIT delivered in a community mental health setting with four urban, low-income, single mothers at risk for child maltreatment. Using a multiple baseline design and direct observation in the home, the research examined changes in positive attention skills (praise,…

Workplaces as Communities: The Role of Social Networks in Who Seeks, Gives, and Accepts Information on Justice Issues

ERIC Educational Resources Information Center

Chia, Ho-Beng; Foo, Maw-Der; Fang, Ruolian

2006-01-01

This article examines individuals in a community as defined by their membership in an organization. In such a setting, individuals often make use of their social contacts to make sense of events in the organization. Yet, the organizational justice literature is generally silent on how these contacts shape information seeking, volunteering, and…

5 CFR 2634.304 - Gifts and reimbursements.

Code of Federal Regulations, 2013 CFR

2013-01-01

.... Example 1. An official accepts a print, a pen and pencil set, and a letter opener from a community service...: $185 Gift 3—Letter opener: $20 The official must disclose Gifts 1 and 2, since together they aggregate.... Example. Items such as a pen and pencil set, letter opener, leather case or engraved pen are generally...

5 CFR 2634.304 - Gifts and reimbursements.

Code of Federal Regulations, 2012 CFR

2012-01-01

.... Example 1. An official accepts a print, a pen and pencil set, and a letter opener from a community service...: $185 Gift 3—Letter opener: $20 The official must disclose Gifts 1 and 2, since together they aggregate.... Example. Items such as a pen and pencil set, letter opener, leather case or engraved pen are generally...

5 CFR 2634.304 - Gifts and reimbursements.

Code of Federal Regulations, 2014 CFR

2014-01-01

.... Example 1. An official accepts a print, a pen and pencil set, and a letter opener from a community service...: $185 Gift 3—Letter opener: $20 The official must disclose Gifts 1 and 2, since together they aggregate.... Example. Items such as a pen and pencil set, letter opener, leather case or engraved pen are generally...

Insights into the structure of plant-insect communities: Specialism and generalism in a regional set of non-pollinating fig wasp communities

NASA Astrophysics Data System (ADS)

Farache, F. H. A.; Cruaud, A.; Rasplus, J.-Y.; Cerezini, M. T.; Rattis, L.; Kjellberg, F.; Pereira, R. A. S.

2018-07-01

Insects show a multitude of symbiotic interactions that may vary in degree of specialization and structure. Gall-inducing insects and their parasitoids are thought to be relatively specialized organisms, but despite their ecological importance, the organization and structure of the interactions they establish with their hosts has seldom been investigated in tropical communities. Non-pollinating fig wasps (NPFW) are particularly interesting organisms for the study of ecological networks because most species strictly develop their offspring within fig inflorescences, and show a multitude of life history strategies. They can be gall-makers, cleptoparasites or parasitoids of pollinating or of other non-pollinating fig wasps. Here we analysed a set of non-pollinating fig wasp communities associated with six species of Ficus section Americanae over a wide area. This allowed us to investigate patterns of specialization in a diverse community composed of monophagous and polyphagous species. We observed that most NPFW species were cleptoparasites and parasitoids, colonizing figs several days after oviposition by pollinators. Most species that occurred in more than one host were much more abundant in a single preferential host, suggesting specialization. The food web established between wasps and figs shows structural properties that are typical of specific antagonistic relationships, especially of endophagous insect networks. Two species that occurred in all available hosts were highly abundant in the network, suggesting that in some cases generalized species can be more competitive than strict specialists. The Neotropical and, to a lesser extent, Afrotropical NPFW communities seem to be more generalized than other NPFW communities. However, evidence of host sharing in the Old World is quite limited, since most studies have focused on particular taxonomic groups (genera) of wasps instead of sampling the whole NPFW community. Moreover, the lack of quantitative information in previous studies prevents us from detecting patterns of host preferences in polyphagous species.

Community walking programs for treatment of peripheral artery disease

PubMed Central

Mays, Ryan J.; Rogers, R. Kevin; Hiatt, William R.; Regensteiner, Judith G.

2013-01-01

Background Supervised walking programs offered at medical facilities for patients with peripheral artery disease (PAD) and intermittent claudication (IC), while effective, are often not utilized due to barriers including lack of reimbursement and the need to travel to specialized locations for the training intervention. Walking programs for PAD patients that occur in community settings, such as those outside of supervised settings, may be a viable treatment option, as they are convenient and potentially bypass the need for supervised walking. This review evaluated the various methodologies and outcomes of community walking programs for PAD. Methods A literature review using appropriate search terms was conducted within PubMed/Medline and the Cochrane databases to identify studies in the English language employing community walking programs to treat PAD patients with IC. Search results were reviewed, and relevant articles were identified that form the basis of this review. The primary outcome was peak walking performance on the treadmill. Results Randomized controlled trials (n=10) examining peak walking outcomes in 558 PAD patients demonstrated that supervised exercise programs were more effective than community walking studies that consisted of general recommendations for patients with IC to walk at home. Recent community trials that incorporated more advice and feedback for PAD patients in general resulted in similar outcomes with no differences in peak walking time compared to supervised walking exercise groups. Conclusions Unstructured recommendations for patients with symptomatic PAD to exercise in the community are not efficacious. Community walking programs with more feedback and monitoring offer improvements in walking performance for patients with claudication and may bypass some obstacles associated with facility-based exercise programs. PMID:24103409

Airport improvement program : military airport program and reliever set-aside update

DOT National Transportation Integrated Search

1996-03-13

This statement by John H. Anderson, Jr., Director, Transportation and : Telecommunications Issues, Resources, Community, and Economic Development : Division, General Accounting Office, before the U. S. House of Representatives : addresses the FAA pro...

Building an evidence base for community health: a review of the quality of program evaluations.

PubMed

Jolley, Gwyn M; Lawless, Angela P; Baum, Fran E; Hurley, Catherine J; Fry, Denise

2007-11-01

An assessment of the quality of program evaluations conducted in South Australian community health services investigated how effective evaluation reporting is in producing an evidence base for community health. Evaluation reports were assessed by a team of reviewers. Practitioner workshops allowed an understanding of the uses of evaluation and what promotes or acts as a barrier to undertaking evaluations. Community health services do undertake a good deal of evaluation. However, reports were not generally explicit in dealing with the principles that underpin community health. Few engaged with program theory or rationale. Typically, reports were of short-term projects with uncertain futures so there may seem little point in considering issues of long-term health outcomes and transferability to other settings. The most important issue from our study is the lack of investment in applied health services research of the sort that will be required to produce the evidence for practice that policy makers desire. The current lack of evidence for community health reflects failure of the system to invest in research and evaluation that is adequately resourced and designed for complex community settings.

Differential relationships between set-shifting abilities and dimensions of insight in schizophrenia.

PubMed

Diez-Martin, J; Moreno-Ortega, M; Bagney, A; Rodriguez-Jimenez, R; Padilla-Torres, D; Sanchez-Morla, E M; Santos, J L; Palomo, T; Jimenez-Arriero, M A

2014-01-01

To assess insight in a large sample of patients with schizophrenia and to study its relationship with set shifting as an executive function. The insight of a sample of 161 clinically stable, community-dwelling patients with schizophrenia was evaluated by means of the Scale to Assess Unawareness of Mental Disorder (SUMD). Set shifting was measured using the Trail-Making Test time required to complete part B minus the time required to complete part A (TMT B-A). Linear regression analyses were performed to investigate the relationships of TMT B-A with different dimensions of general insight. Regression analyses revealed a significant association between TMT B-A and two of the SUMD general components: 'awareness of mental disorder' and 'awareness of the efficacy of treatment'. The 'awareness of social consequences' component was not significantly associated with set shifting. Our results show a significant relation between set shifting and insight, but not in the same manner for the different components of the SUMD general score. Copyright © 2013 S. Karger AG, Basel.

Characterization of Biofilm Community Structure by Ribosomal RNA sequences

DTIC Science & Technology

1989-12-01

for strains of Fibrobacter, 2) Desulfobacter genus-specific probe, 3) Desulfosarcina genus-specific probe, 4) archaebacterial kingdom -specific probes...and 5) eubacterial kingdom -specific probes 5) eukaryote kingdom -specific probe and 6) a general probe encompassing all characterized sulfate-reducing...sets have been fabricated. The group-specific primer sets selectively amplify either sulfate-reducing bacteria or archaebacteria . The SRB-specific

Robust estimation of microbial diversity in theory and in practice

PubMed Central

Haegeman, Bart; Hamelin, Jérôme; Moriarty, John; Neal, Peter; Dushoff, Jonathan; Weitz, Joshua S

2013-01-01

Quantifying diversity is of central importance for the study of structure, function and evolution of microbial communities. The estimation of microbial diversity has received renewed attention with the advent of large-scale metagenomic studies. Here, we consider what the diversity observed in a sample tells us about the diversity of the community being sampled. First, we argue that one cannot reliably estimate the absolute and relative number of microbial species present in a community without making unsupported assumptions about species abundance distributions. The reason for this is that sample data do not contain information about the number of rare species in the tail of species abundance distributions. We illustrate the difficulty in comparing species richness estimates by applying Chao's estimator of species richness to a set of in silico communities: they are ranked incorrectly in the presence of large numbers of rare species. Next, we extend our analysis to a general family of diversity metrics (‘Hill diversities'), and construct lower and upper estimates of diversity values consistent with the sample data. The theory generalizes Chao's estimator, which we retrieve as the lower estimate of species richness. We show that Shannon and Simpson diversity can be robustly estimated for the in silico communities. We analyze nine metagenomic data sets from a wide range of environments, and show that our findings are relevant for empirically-sampled communities. Hence, we recommend the use of Shannon and Simpson diversity rather than species richness in efforts to quantify and compare microbial diversity. PMID:23407313

Pediatric Dental Patients are Part of a Larger Picture: Detailing Population Realities.

PubMed

Waldman, H B; Perlman, S P

2015-01-01

The traditional setting of a dental practice may offer pediatric dentists a potentially isolated picture of the general health and use of health services by youngsters in their community. Results from the latest National Health Interview Survey are reviewed to provide broad dimensions to supplement and reinforce the general and specific information usually developed regarding individual patients.

General practice recruitment for people at risk of schizophrenia: the Buckingham experience.

PubMed

Falloon, I R

2000-11-01

The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings. A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project. General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered. It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.

A Comparison of the Wellbeing of Orphans and Abandoned Children Ages 6–12 in Institutional and Community-Based Care Settings in 5 Less Wealthy Nations

PubMed Central

Whetten, Kathryn; Ostermann, Jan; Whetten, Rachel A.; Pence, Brian W.; O'Donnell, Karen; Messer, Lynne C.; Thielman, Nathan M.

2009-01-01

Background Leaders are struggling to care for the estimated 143,000,000 orphans and millions more abandoned children worldwide. Global policy makers are advocating that institution-living orphans and abandoned children (OAC) be moved as quickly as possible to a residential family setting and that institutional care be used as a last resort. This analysis tests the hypothesis that institutional care for OAC aged 6–12 is associated with worse health and wellbeing than community residential care using conservative two-tail tests. Methodology The Positive Outcomes for Orphans (POFO) study employed two-stage random sampling survey methodology in 6 sites across 5 countries to identify 1,357 institution-living and 1,480 community-living OAC ages 6–12, 658 of whom were double-orphans or abandoned by both biological parents. Survey analytic techniques were used to compare cognitive functioning, emotion, behavior, physical health, and growth. Linear mixed-effects models were used to estimate the proportion of variability in child outcomes attributable to the study site, care setting, and child levels and institutional versus community care settings. Conservative analyses limited the community living children to double-orphans or abandoned children. Principal Findings Health, emotional and cognitive functioning, and physical growth were no worse for institution-living than community-living OAC, and generally better than for community-living OAC cared for by persons other than a biological parent. Differences between study sites explained 2–23% of the total variability in child outcomes, while differences between care settings within sites explained 8–21%. Differences among children within care settings explained 64–87%. After adjusting for sites, age, and gender, institution vs. community-living explained only 0.3–7% of the variability in child outcomes. Conclusion This study does not support the hypothesis that institutional care is systematically associated with poorer wellbeing than community care for OAC aged 6–12 in those countries facing the greatest OAC burden. Much greater variability among children within care settings was observed than among care settings type. Methodologically rigorous studies must be conducted in those countries facing the new OAC epidemic in order to understand which characteristics of care promote child wellbeing. Such characteristics may transcend the structural definitions of institutions or family homes. PMID:20020037

Unconference session at the IAU General Assembly 2015

NASA Astrophysics Data System (ADS)

Nava, Tibisay Sankatsing; Venugopal, Ramasamy; Verdolini, Silvia

2016-10-01

The Astronomy For Development Focus Meeting 20 at the IAU General Assembly encompassed an `Unconference' session as part of the proceedings. Unstructured conferences, with their potential to unleash innovative ideas, are gaining traction in various conferences and symposia. Astronomy For Development is a field that is applicable to the entire Astronomy community (and even beyond) and hence an unconference inviting ideas and fostering frank dialogue is very pertinent. Officially one of the final sessions of the the 2015 General Assembly, the unconference session was intended to provide a balanced platform for a diverse set of participants and act as an informal setting to promote open discussion on topics of relevance to Astronomy for Development.

Medical residencies and increased admissions in rural hospitals with fewer than 200 beds.

PubMed

Connor, R A

2000-01-01

Medical education programs in general, and rural residency programs in particular, can be beneficial for rural hospitals. This study of 1,792 non-metropolitan statistical area, acute general hospitals with fewer than 200 beds from 1993 to 1996 was designed to help rural hospitals and communities to quantify the likely effects of rural residency programs on hospital admissions. Data came from the hospital Prospective Payment System minimum data set. The results show that additional residents at rural hospitals with fewer than 200 beds generally result in an increase of approximately 100 to 200 admissions per resident--more for smaller hospitals and fewer for larger hospitals. Because increased admissions generally improve the financial health and continued operation of rural hospitals, this study confirms the importance of education-based strategies in ensuring access to care in rural communities.

Communitarian claims and community capabilities: furthering priority setting?

PubMed

Mooney, Gavin

2005-01-01

Priority setting in health care is generally not done well. This paper draws on ideas from Amartya Sen and Martha Nussbaum and adds some communitarian underpinnings to provide a way of improving on current uses of program budgeting and marginal analysis (PBMA) in priority setting. The paper suggests that shifting to a communitarian base for priority setting alters the distribution of property rights over health service decision making and increases the probability that recommendations from PBMA exercises will be implemented. The approach is built on a paradigm which departs from three tenets of welfarism as it is normally conceived: (i) individuals qua individuals seek to maximise their individual utility/well-being; (ii) individuals want to do this; and (iii) it is the values of individuals qua individuals that count. Some of the problems of PBMA, as it has been applied to date, are highlighted. It is argued that these are due largely to a lack of 'credible commitment'. Bringing in the community and communitarian values to PBMA priority setting exercises can help to overcome some of the barriers to getting PBMA recommendations implemented. The approach has the merit of reflecting Sen's concept of capabilities (but extending that to a community level). It avoids the often consequentialist base of a conventional welfarist framework, and it allows community values as opposed to individual values to come to the fore. How to elicit communitarian values is explored.

Examining the Specific Effects of Context on Adaptive Behavior and Achievement in a Rural African Community: Six Case Studies from Rural Areas of Southern Province, Zambia

ERIC Educational Resources Information Center

Tan, Mei; Reich, Jodi; Hart, Lesley; Thuma, Philip E.; Grigorenko, Elena L.

2014-01-01

Generally accepted as universal, the construct of adaptive behavior differs in its manifestations across different cultures and settings. The Vineland-II (Sparrow et al. in "Vineland Adaptive Behavior Scales, Second edn." AGS Publishing, Circle Pines, MN, 2005) was translated into Chitonga and adapted to the setting of rural Southern…

Building community resilience through mental health infrastructure and training in post-Katrina New Orleans.

PubMed

Springgate, Benjamin F; Wennerstrom, Ashley; Meyers, Diana; Allen, Charles E; Vannoy, Steven D; Bentham, Wayne; Wells, Kenneth B

2011-01-01

To describe a disaster recovery model focused on developing mental health services and capacity-building within a disparities-focused, community-academic participatory partnership framework. Community-based participatory, partnered training and services delivery intervention in a post-disaster setting. Post-Katrina Greater New Orleans community. More than 400 community providers from more than 70 health and social services agencies participated in the trainings. Partnered development of a training and services delivery program involving physicians, therapists, community health workers, and other clinical and non-clinical personnel to improve access and quality of care for mental health services in a post-disaster setting. Services delivery (outreach, education, screening, referral, direct treatment); training delivery; satisfaction and feedback related to training; partnered development of training products. Clinical services in the form of outreach, education, screening, referral and treatment were provided in excess of 110,000 service units. More than 400 trainees participated in training, and provided feedback that led to evolution of training curricula and training products, to meet evolving community needs over time. Participant satisfaction with training generally scored very highly. This paper describes a participatory, health-focused model of community recovery that began with addressing emerging, unmet mental health needs using a disparities-conscious partnership framework as one of the principle mechanisms for intervention. Population mental health needs were addressed by investment in infrastructure and services capacity among small and medium sized non-profit organizations working in disaster-impacted, low resource settings.

A qualitative exploration of opinions on the community pharmacists' role amongst the general public in Scotland.

PubMed

Gidman, Wendy; Cowley, Joseph

2013-10-01

To understand members of the public's opinions and experiences of pharmacy services. This exploratory study employed qualitative methods. Five focus groups were conducted with 26 members of the public resident in Scotland in March 2010. The groups comprised those perceived to be users and non-users of community pharmacy. A topic guide was developed to prompt discussion. Each focus group was recorded, transcribed, anonymised and analysed using thematic analysis. Participants made positive comments about pharmacy services although many preferred to see a general practitioner (GP). Participants discussed using pharmacies for convenience, often because they were unable to access GPs. Pharmacists were perceived principally to be suppliers of medicine, although there was some recognition of roles in dealing with minor ailments and providing advice. For those with serious and long-standing health matters GPs were usually the professional of choice for most health needs. Community pharmacy was seen to offer incomplete services which did not co-ordinate well with other primary-care services. The pharmacy environment and retail setting were not considered to be ideal for private healthcare consultations. This study suggests that despite recent initiatives to extend the role of community pharmacists many members of the general public continue to prefer a GP-led service. Importantly GPs inspire public confidence as well as offering comprehensive services and private consultation facilities. Improved communication and information sharing between community pharmacists and general practice could support community pharmacist-role expansion. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

Pharmacists' perspectives of the current status of pediatric asthma management in the U.S. community pharmacy setting.

PubMed

Elaro, Amanda; Bosnic-Anticevich, Sinthia; Kraus, Kathleen; Farris, Karen B; Shah, Smita; Armour, Carol; Patel, Minal R

2017-08-01

Objective To explore community pharmacists' continuing education, counseling and communication practices, attitudes and barriers in relation to pediatric asthma management. Setting Community pharmacies in Michigan, United States. Methods Between July and September 2015 a convenience sample of community pharmacists was recruited from southeastern Michigan and asked to complete a structured, self-reported questionnaire. The questionnaire elucidated information on 4 general domains relating to pharmacists' pediatric asthma management including: (1) guidelines and continuing education (CE); (2) counseling and medicines; (3) communication and self-management practices; (4) attitudes and barriers to practice. Regression analyses were conducted to determine predictors towards pharmacists' confidence/frequency of use of communication/counseling strategies. Main outcome measure Confidence in counseling skills around asthma. Results 105 pharmacists completed the study questionnaire. Fifty-four percent of pharmacists reported participating in asthma related CE in the past year. Over 70% of pharmacists reported confidence in general communication skills, while a lower portion reported confidence in engaging in higher order self-management activities that involved tailoring the regimen (58%), decision-making (50%) and setting short-term (47%) and long-term goals (47%) with the patient and caregiver for managing asthma at home. Pharmacists who reported greater use of recommended communication/self-management strategies were more likely to report confidence in implementing these communication/self-management strategies when counseling caregivers and children with asthma [Beta (B) Estimate 0.58 SE (0.08), p < 0.001]. Female pharmacists [B Estimate -2.23 SE (1.01), p < 0.05] and those who reported beliefs around doctors being the sole provider of asthma education [B Estimate -1.00 SE (0.32), p < 0.01] were less likely to report confidence in implementing communication/self-management strategies. Conclusion A pharmacists' confidence may influence their ability to implement recommended self-management counseling strategies. This study showed that community pharmacists are confident in general communication. However pharmacists are reporting lower confidence levels in counseling on higher order self-management strategies with patients. More appropriate and targeted continuing education programs for pharmacists around asthma self-management education are recommended.

What works in Indigenous tobacco control? The perceptions of remote Indigenous community members and health staff.

PubMed

Johnston, Vanessa; Thomas, David P

2010-04-01

To explore the perceptions of remote Indigenous community members and health staff regarding the acceptability and effectiveness of different tobacco control health promotion interventions. Qualitative methods were used for this exploratory study, including interviews with remote Indigenous community members and health staff, as well as observations of the delivery of different tobacco control activities in three remote communities in the Northern Territory (NT). Several tobacco control interventions for which there is strong evidence in other settings were generally perceived as acceptable and efficacious in the remote Indigenous setting. Primary care interventions, such as brief advice and pharmaceutical quitting aids, when available and accessible, were perceived as important and effective strategies to help people quit, as were the promotion of smokefree areas. By contrast unmodified Quit programs were perceived to have questionable application in this context and there were conflicting findings regarding taxation increases on tobacco and social marketing campaigns. Several evidence-based 'mainstream' activities are perceived to be acceptable to this population, but we may also need to address the concerns raised by health staff and community members about the acceptability of some unmodified activities. Additionally, organisational barriers within the health system may be contributing to the reduced effectiveness of tobacco control in this setting.

Pharmacy patronage: identifying key factors in the decision making process using the determinant attribute approach.

PubMed

Franic, Duska M; Haddock, Sarah M; Tucker, Leslie Tootle; Wooten, Nathan

2008-01-01

To use the determinant attribute approach, a research method commonly used in marketing to identify the wants of various consumer groups, to evaluate consumer pharmacy choice when having a prescription order filled in different pharmacy settings. Cross sectional. Community independent, grocery store, community chain, and discount store pharmacies in Georgia between April 2005 and April 2006. Convenience sample of adult pharmacy consumers (n = 175). Survey measuring consumer preferences on 26 attributes encompassing general pharmacy site features (16 items), pharmacist characteristics (5 items), and pharmacy staff characteristics (5 items). 26 potential determinant attributes for pharmacy selection. 175 consumers were surveyed at community independent (n = 81), grocery store (n = 44), community chain (n = 27), or discount store (n = 23) pharmacy settings. The attributes of pharmacists and staff at all four pharmacy settings were shown to affect pharmacy patronage motives, although consumers frequenting non-community independent pharmacies were also motivated by secondary convenience factors, e.g., hours of operation, and prescription coverage. Most consumers do not perceive pharmacies as merely prescription-distribution centers that vary only by convenience. Prescriptions are not just another economic good. Pharmacy personnel influence pharmacy selection; therefore, optimal staff selection and training is likely the greatest asset and most important investment for ensuring pharmacy success.

Expanding Public Outreach: The Solar System Ambassadors Program

NASA Astrophysics Data System (ADS)

Ferrari, K. A.

2000-12-01

The Solar System Ambassadors Program is a public outreach program designed to work with motivated volunteers across the nation. Those volunteers organize and conduct public events that communicate exciting discoveries and plans in Solar System research, exploration and technology through non-traditional forums, e.g. community service clubs, libraries, museums, planetariums, ``star parties," mall displays, etc. In 2001, 200 Ambassadors from almost all 50 states bring the excitement of space to the public. Ambassadors are space enthusiasts, K-12 in-service educators, retirees, community college teachers, and other members of the general public interested in providing greater service and inspiration to the community at large. Last year, Ambassadors conducted approximately 600 events that directly reached more than one-half million people in communities across the United States. The Solar System Ambassadors Program is sponsored by the Jet Propulsion Laboratory (JPL) in Pasadena, California, an operating division of the California Institute of Technology (Caltech) and a lead research and development center for the National Aeronautics and Space Administration (NASA). Participating JPL projects include Cassini, Galileo, STARDUST, Outer Planets mission, Solar Probe, Genesis, Ulysses, Voyager, Mars missions, Discovery missions NEAR-Shoemaker and Deep Impact, and the Deep Space Network. Each Ambassador participates in on-line (web-based) training sessions that provide interaction with NASA scientists, engineers and project team members. As such, each Ambassador's experience with the space program becomes personalized. Training sessions provide Ambassadors with general background on each mission and educate concerning specific mission milestones, such as launches, planetary flybys, first image returns, arrivals, and ongoing key discoveries. Additionally, projects provide videos, slide sets, booklets, pamphlets, posters, postcards, lithographs, on-line materials, resource links and information. Integrating nation-wide volunteers in a public-engagement program helps optimize project funding set aside for education and outreach purposes. At the same time, members of communities across the country become an extended part of each mission's team and an important interface between the space exploration community and the general public at large.

Does community health care require different competencies from physicians and nurses?

PubMed Central

2014-01-01

Background Recently competency approach in Health Professionals’ Education (HPE) has become quite popular and for an effective competency based HPE, it is important to design the curriculum around the health care needs of the population to be served and on the expected roles of the health care providers. Unfortunately, in community settings roles of health providers tend to be described less clearly, particularly at the Primary Health Care (PHC) level where a multidisciplinary and appropriately prepared health team is generally lacking. Moreover, to tailor the education on community needs there is no substantial evidence on what specific requirements the providers must be prepared for. Methods This study has explored specific tasks of physicians and nurses employed to work in primary or secondary health care units in a context where there is a structural scarcity of community health care providers. In-depth Interviews of 11 physicians and 06 nurses working in community settings of Pakistan were conducted along with review of their job descriptions. Results At all levels of health settings, physicians’ were mostly engaged with diagnosing and prescribing medical illness of patients coming to health center and nurses depending on their employer were either providing preventive health care activities, assisting physicians or occupied in day to day management of health center. Geographical location or level of health facility did not have major effect on the roles being expected or performed, however the factors that determined the roles performed by health providers were employer expectations, preparation of health providers for providing community based care, role clarity and availability of resources including health team at health facilities. Conclusions Exploration of specific tasks of physicians and nurses working in community settings provide a useful framework to map competencies, and can help educators revisit the curricula and instructional designs accordingly. Furthermore, in community settings there are many synergies between the roles of physicians and nurses which could be simulated as learning activities; at the same time these two groups of health providers offer distinct sets of services, which must be harnessed to build effective, non-hierarchal, collaborative health teams. PMID:24387322

Using Art Installations as Action Research to Engage Children and Communities in Evaluating and Redesigning City Centre Spaces

ERIC Educational Resources Information Center

Percy-Smith, Barry; Carney, Clare

2011-01-01

This paper discusses learning from a project that set out to explore how the general public perceived the value of public art in the context of urban regeneration of a city centre space. Whilst not set up explicitly as an action research project, the paper discusses the way in which participatory public art projects of this kind can be understood…

IFLA General Conference, 1990. Division of Libraries Serving the General Public: Section on Public Libraries; Section of Children's Libraries, Children's Literature Documentation Centres, Round Table; Section of School Libraries; Section of Libraries for the Blind; INTAMEL, Round Table; Mobile Libraries, Round Table. Booklet 3.

ERIC Educational Resources Information Center

International Federation of Library Associations, The Hague (Netherlands).

The 28 papers in this collection were presented at meetings of four sections and three round tables within the Division of Libraries Serving the General Public: (1) "Rural Community Information Services: Guidelines for Researching Need, Setting Up Services and Evaluating Performance" (Elaine Kempson); (2) "Library Activities at the Workplace"…

Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review.

PubMed

Moore, Lizzie; Chersich, Matthew F; Steen, Richard; Reza-Paul, Sushena; Dhana, Ashar; Vuylsteke, Bea; Lafort, Yves; Scorgie, Fiona

2014-06-10

Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little is known about similar approaches in African settings. We systematically reviewed community empowerment processes within FSW SRH projects in Africa, and assessed them using a framework developed by Ashodaya, an Indian sex worker organisation. In November 2012 we searched Medline and Web of Science for studies of FSW health services in Africa, and consulted experts and websites of international organisations. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on service-delivery models and degree of FSW involvement, and analysed with reference to a four-stage framework developed by Ashodaya. This conceptualises community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally, (4) sustainability of action beyond the community. Of 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW 'hotspots' were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioural and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations. Most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings.

Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review

PubMed Central

2014-01-01

Background Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little is known about similar approaches in African settings. We systematically reviewed community empowerment processes within FSW SRH projects in Africa, and assessed them using a framework developed by Ashodaya, an Indian sex worker organisation. Methods In November 2012 we searched Medline and Web of Science for studies of FSW health services in Africa, and consulted experts and websites of international organisations. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on service-delivery models and degree of FSW involvement, and analysed with reference to a four-stage framework developed by Ashodaya. This conceptualises community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally, (4) sustainability of action beyond the community. Results Of 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW ‘hotspots’ were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioural and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations. Conclusions Most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings. PMID:24916108

Spirituality, depression, living alone, and perceived health among Korean older adults in the community.

PubMed

You, Kwang Soo; Lee, Hae-Ok; Fitzpatrick, Joyce J; Kim, Susie; Marui, Eiji; Lee, Jung Su; Cook, Paul

2009-08-01

Both theoretical and empirical studies have documented the protective effect of religiosity and spirituality on general health in older adults in community and hospital settings; however, no study has documented the relationship between spirituality and depression among older adults living alone in communities in Korea. We tested two hypotheses: Hypothesis 1: Korean older adults living alone would be more depressed and less healthy than older adults living with family, and Hypothesis 2: Individuals who are more religious and spiritual would report a lower level of depression and a higher level of general health even when other demographic and living status variables are controlled. A descriptive, comparative, and correlational design with a convenience sampling method was conducted among community-dwelling Korean older adults in Chounbook Providence, South Korea. This study included 152 men and women older than 65 years old. Hypothesis 1 was supported as Korean older adults living alone were significantly more depressed than were older adults living with family (P<.01). However, for Hypotheses 2, only spirituality activities and Spirituality Index of Well-Being scores were significantly associated with general health and/or depression (P<.01), but there were no relationships between the variables of attendance and importance of religion with general health and depression.

Residential therapeutic communities in the mainstream: diversity and issues.

PubMed

De Leon, G

1995-01-01

Not all residential drug abuse treatment programs are therapeutic communities (TCs), not all TCs are in residential settings, and not all programs that call themselves TCs employ the same social and psychological models of treatment. The term "therapeutic community" is widely used to represent a distinct approach in almost any setting, including community residences, hospital wards, prisons, and homeless shelters. One effect of this labeling has been to cloud understanding of the TC as a drug abuse treatment approach, how well it works, where it works best, and for which clients it is most appropriate. This article attempts to further a general understanding of residential TCs. Distinctions are drawn between residential drug abuse treatment and residential TCs. The diversity of programs within the TC modality is described in terms of modifications of the model and applications to special populations; and the essential elements of the TC program model are briefly outlined. Finally, movement into the mainstream has surfaced issues for the TC in terms of policy and practice, several of which are highlighted.

A Finnish validation study of the SCL-90.

PubMed

Holi, M M; Sammallahti, P R; Aalberg, V A

1998-01-01

The Symptom Check-List-90 (SCL-90) is a widely used psychiatric questionnaire which has not yet been validated in Finland. We investigated the utility of the translated version of the SCL-90 in the Finnish population, and set community norms for it. The internal consistency of the original subscales was checked and found to be good. Discriminant function analysis, based on the nine original subscales, showed that the power of the SCL-90 to discriminate between patients and the community is good. Factor analysis of the items of the questionnaire yielded a very strong unrotated first factor, suggesting that a general factor may be present. This together with the fact that high intercorrelations were found between the nine original subscales suggests that the instrument is not multidimensional. The SCL-90 may be useful in a research setting as an instrument for measuring the change in symptomatic distress, or as a screening instrument. The American community norms should be used with caution, as the Finnish community sample scored consistently higher on all subscales.

Understanding low colorectal cancer screening uptake in South Asian faith communities in England--a qualitative study.

PubMed

Palmer, Cecily K; Thomas, Mary C; McGregor, Lesley M; von Wagner, Christian; Raine, Rosalind

2015-10-01

Colorectal cancer screening uptake within the South Asian population in England is approximately half that of the general population (33 % vs 61 %), and varies by Muslim (31.9 %), Sikh (34.6 %) and Hindu (43.7 %) faith background. This study sought to explore reasons for low uptake of CRC screening in South Asian communities and for the variability of low uptake between three faith communities; and to identify strategies by which uptake might be improved. We interviewed 16 'key informants' representing communities from the three largest South Asian faith backgrounds (Islam, Hinduism and Sikhism) in London, England. Reasons for low colorectal cancer screening uptake were overwhelmingly shared across South Asian faith groups. These were: limitations posed by written English; limitations posed by any written language; reliance on younger family members; low awareness of colorectal cancer and screening; and difficulties associated with faeces. Non-written information delivered verbally and interactively within faith or community settings was preferred across faith communities. Efforts to increase accessibility to colorectal cancer screening in South Asian communities should use local language broadcasts on ethnic media and face-to-face approaches within community and faith settings to increase awareness of colorectal cancer and screening, and address challenges posed by written materials.

40 CFR 300.500 - General.

Code of Federal Regulations, 2010 CFR

2010-07-01

... COMMUNITY RIGHT-TO-KNOW PROGRAMS NATIONAL OIL AND HAZARDOUS SUBSTANCES POLLUTION CONTINGENCY PLAN State... either assume the lead through a cooperative agreement for the response action or may be the support agency in EPA-lead remedial response. Section 300.515 sets forth requirements for state involvement in...

User guide to the Magellan synthetic aperture radar images

NASA Technical Reports Server (NTRS)

Wall, Stephen D.; Mcconnell, Shannon L.; Leff, Craig E.; Austin, Richard S.; Beratan, Kathi K.; Rokey, Mark J.

1995-01-01

The Magellan radar-mapping mission collected a large amount of science and engineering data. Now available to the general scientific community, this data set can be overwhelming to someone who is unfamiliar with the mission. This user guide outlines the mission operations and data set so that someone working with the data can understand the mapping and data-processing techniques used in the mission. Radar-mapping parameters as well as data acquisition issues are discussed. In addition, this user guide provides information on how the data set is organized and where specific elements of the set can be located.

Geometric derivations of minimal sets of sufficient multiview constraints

USGS Publications Warehouse

Thomas, Orrin H.; Oshel, Edward R.

2012-01-01

Geometric interpretations of four of the most common determinant formulations of multiview constraints are given, showing that they all enforce the same geometry and that all of the forms commonly in use in the machine vision community are a subset of a more general form. Generalising the work of Yi Ma yields a new general 2 x 2 determinant trilinear and 3 x 3 determinant quadlinear. Geometric descriptions of degenerate multiview constraints are given, showing that it is necessary, but insufficient, that the determinant equals zero. Understanding the degeneracies leads naturally into proofs for minimum sufficient sets of bilinear, trilinear and quadlinear constraints for arbitrary numbers of conjugate observations.

The psychological and psychiatric effects of terrorism: lessons from London.

PubMed

Rubin, G James; Wessely, Simon

2013-09-01

The 7 July 2005 bombings in London caused heightened levels of distress among some in the general community. This distress was most notable in Muslims and members of ethnic minority groups. These effects were transient for most. An estimated 30% of those who were more affected by the attacks, including victims and witnesses, developed psychiatric disorders as a result. An outreach program was set up to screen those who were exposed to potentially traumatic events and to offer them evidence-based treatment. This article discusses what lessons might be learned from studies of the general community and the screen-and-treat approach. Copyright © 2013 Elsevier Inc. All rights reserved.

Clinic Services for Persons with AIDS

PubMed Central

Markson, Leona E; Turner, Barbara J; Cocroft, Jim; Houchens, Robert; Fanning, Thomas R

1997-01-01

OBJECTIVE To profile characteristics of clinics caring for persons with advanced HIV infection. DESIGN AND SETTING Survey of clinic directors in New York State. PARTICIPANTS Newly diagnosed Medicaid-enrolled AIDS patients in New York state in federal fiscal years 1987–1992 (n = 6,184) managed by 62 HIV specialty, 53 hospital-based general medicine/primary care, 36 community-based primary care, and 28 other clinics. MEASUREMENTS AND MAIN RESULTS Telephone survey about clinic hours, emphasis on HIV, staffing, procedures, and directors’ rating of care. Estimates of the number of newly diagnosed, Medicaid-enrolled AIDS patients treated in surveyed clinics were obtained from claims data. We found that community-based clinics were significantly more likely to have longer hours, a physician on call, or to accommodate unscheduled care than were hospital-based general medicine/primary care or other types of clinics. Compared with HIV specialty clinics, general medicine/primary care clinics were less likely to have HIV-specific care attributes such as a director of HIV care (98% vs 72%), multidisciplinary conferences on HIV care (83% vs 32%), or a standard initial HIV workup (90% vs 70%). Of general medicine/primary care clinics, most (83%) were staffed by residents and fellows compared with only 68% of HIV or 25% of community-based clinics (p < .001). General medicine/primary care clinics were less likely than community-based clinics to perform Pap smears (75% vs 94%) or to have case managers on payroll (21% vs 81%). CONCLUSIONS In this sample of clinics, hospital-based general medicine/primary care clinics managing the care of Medicaid enrollees with AIDS appeared to have more limited hours and availability of specific services than HIV specialty or community-based clinics.

A method to estimate the additional uncertainty in gap-filled NEE resulting from long gaps in the CO2 flux record

Treesearch

Andrew D. Richardson; David Y. Hollinger

2007-01-01

Missing values in any data set create problems for researchers. The process by which missing values are replaced, and the data set is made complete, is generally referred to as imputation. Within the eddy flux community, the term "gap filling" is more commonly applied. A major challenge is that random errors in measured data result in uncertainty in the gap-...

Teaching adolescents with severe disabilities to use the public telephone.

PubMed

Test, D W; Spooner, F; Keul, P K; Grossi, T

1990-04-01

Two adolescents with severe disabilities served as participants in a study conducted to train in the use of the public telephone to call home. Participants were trained to complete a 17-step task analysis using a training package which consisted of total task presentation in conjunction with a four-level prompting procedure (i.e., independent, verbal, verbal + gesture, verbal + guidance). All instruction took place in a public setting (e.g., a shopping mall) with generalization probes taken in two alternative settings (e.g., a movie theater and a convenience store). A multiple probe across individuals design demonstrated the training package was successful in teaching participants to use the telephone to call home. In addition, newly acquired skills generalized to the two untrained settings. Implications for community-based training are discussed.

No Vacation from Bullying: A Summer Camp Intervention Pilot Study

ERIC Educational Resources Information Center

Carney, Amy G.; Nottis, Kathryn E. K.

2008-01-01

Within school environments, where bullying interventions are usually studied, the preponderance of bullying incidents generally occur in less structured settings (Hazler, 1996; Leff, Power, Costigan, & Manz, 2003; Olweus, 1997). Outside of school, children spend time in relatively unstructured community environments, with minimally trained staff.…

Cardio-respiratory Outcomes Associated with Exposure to Wildfire Smoke are Modified by Measures of Community Health

EPA Science Inventory

Background: Characterizing factors which determine susceptibility to air pollution is an important step in understanding the distribution of risk in a population and is a critical for setting appropriate air quality management policies. Objective: To evaluate general and specif...

Shopping for Courses on the Mall.

ERIC Educational Resources Information Center

Gallagher, John C.

1980-01-01

Describes an extension program conducted by Suffolk County Community College, New York, at an area shopping mall. Discusses program offerings, including a series of general interest lectures, regular credit courses, and a set of noncredit minicourses for mall employees. Examines the public relations value of the extension efforts. (JP)

Community detection for networks with unipartite and bipartite structure

NASA Astrophysics Data System (ADS)

Chang, Chang; Tang, Chao

2014-09-01

Finding community structures in networks is important in network science, technology, and applications. To date, most algorithms that aim to find community structures only focus either on unipartite or bipartite networks. A unipartite network consists of one set of nodes and a bipartite network consists of two nonoverlapping sets of nodes with only links joining the nodes in different sets. However, a third type of network exists, defined here as the mixture network. Just like a bipartite network, a mixture network also consists of two sets of nodes, but some nodes may simultaneously belong to two sets, which breaks the nonoverlapping restriction of a bipartite network. The mixture network can be considered as a general case, with unipartite and bipartite networks viewed as its limiting cases. A mixture network can represent not only all the unipartite and bipartite networks, but also a wide range of real-world networks that cannot be properly represented as either unipartite or bipartite networks in fields such as biology and social science. Based on this observation, we first propose a probabilistic model that can find modules in unipartite, bipartite, and mixture networks in a unified framework based on the link community model for a unipartite undirected network [B Ball et al (2011 Phys. Rev. E 84 036103)]. We test our algorithm on synthetic networks (both overlapping and nonoverlapping communities) and apply it to two real-world networks: a southern women bipartite network and a human transcriptional regulatory mixture network. The results suggest that our model performs well for all three types of networks, is competitive with other algorithms for unipartite or bipartite networks, and is applicable to real-world networks.

General practitioners as educators in adolescent health: a training evaluation.

PubMed

Van de Mortel, Thea; Bird, Jennifer; Chown, Peter; Trigger, Robert; Ahern, Christine

2016-03-22

General practitioners play an important role in the primary care of adolescents in both community and clinical settings. Yet studies show that GPs can lack confidence, skills and knowledge in adolescent health. This study evaluates the effectiveness of an innovative training intervention on medical participants' knowledge and confidence as adolescent health educators in a school setting. 15 general practitioners, 12 general practice registrars and 18 medical students participated in an adolescent health education workshop followed by field experience in health education sessions in secondary schools. The mixed method design included a pre and post intervention survey and focus group interviews. Mean scores on the Confidence to Teach scale increased significantly (3.34 ± 0.51 to 4.09 ± 0.33) (p < .001) as did confidence to communicate with adolescents (3.64 ± 0.48 to 4.19 ± 0.33) (p < .001). Mean knowledge scores increased significantly (7.00 ± 1.22 to 8.98 ± 1.11) (p < .001). Participants highlighted the value of learning about adolescent health issues and generic teaching skills especially lesson planning and design, practicing experiential teaching strategies and finding the 'sweet spot' when communicating with adolescents. Some participants reported that these skills would transfer to the practice setting. An applied training intervention that uses evidence-based, experiential teaching strategies and focuses on developing knowledge and practical teaching skills appropriate for the health education of adolescents can enhance knowledge and confidence to engage in community-based adolescent health education.

Therapeutic Horseback Riding Outcomes of Parent-Identified Goals for Children with Autism Spectrum Disorder: An ABA′ Multiple Case Design Examining Dosing and Generalization to the Home and Community

PubMed Central

Baird, Joanne M.; Kim, Young Joo; Rajora, Kuwar B.; D’Silva, Delma; Podolinsky, Lin; Mazefsky, Carla; Minshew, Nancy

2014-01-01

We examined whether different doses of therapeutic riding influenced parent-nominated target behaviors of children with autism spectrum disorder (ASD) (a) during the session (b) at home, and (c) in the community. We used a single subject multiple Baseline, multiple case design, with dosing of 1, 3, and 5 times/week. Three boys with ASD, 6–8 years of age participated, and counts of target behaviors were collected in each setting and phase of the study. Compared to Baseline, 70 % of the target behaviors were better during Intervention and improvement was retained in 63 % of the behaviors during Withdrawal. Increased doses of therapeutic riding were significant for magnitude of change, and the effect of the therapeutic riding sessions generalized to home and community. PMID:24091469

Working With Solar System Ambassadors

NASA Astrophysics Data System (ADS)

Ferrari, K.

2001-11-01

The Solar System Ambassadors Program is a public outreach program designed to work with motivated volunteers across the nation. These competitively selected volunteers organize and conduct public events that communicate exciting discoveries and plans in Solar System research, exploration and technology through non-traditional forums; e.g. community service clubs, libraries, museums, planetariums, "star parties," mall displays, etc. Each Ambassador participates in on-line (web-based) training sessions that provide interaction with NASA scientists, engineers and project team members. As such, each Ambassador's experience with the space program becomes personalized. Training sessions provide Ambassadors with general background on each mission and educate them concerning specific mission milestones, such as launches, planetary flybys, first image returns, arrivals, and ongoing key discoveries. Additionally, projects provide limited supplies of videos, slide sets, booklets, pamphlets, posters, postcards, lithographs, on-line materials, resource links and information. In addition to participating in on-line trainings with Ambassadors, scientists will be given the opportunity to interact with, and mentor volunteer Ambassadors at regional, weekend conferences designed to strengthen the Ambassadors' knowledge of space science and exploration, thereby improving the space science message that goes out to the general public through these enthusiastic volunteers. Integrating volunteers across the country in a public-engagement program helps optimize project funding set aside for education and outreach purposes, establishing a nationwide network of regional contacts. At the same time, members of communities across the country become an extended part of each mission's team and an important interface between the space exploration community and the general public at large.

Comparative Initial and Sustained Engagement in Web-based Training by Behavioral Healthcare Providers in New York State.

PubMed

Talley, Rachel; Chiang, I-Chin; Covell, Nancy H; Dixon, Lisa

2018-06-01

Improved dissemination is critical to implementation of evidence-based practice in community behavioral healthcare settings. Web-based training modalities are a promising strategy for dissemination of evidence-based practice in community behavioral health settings. Initial and sustained engagement of these modalities in large, multidisciplinary community provider samples is not well understood. This study evaluates comparative engagement and user preferences by provider type in a web-based training platform in a large, multidisciplinary community sample of behavioral health staff in New York State. Workforce make-up among platform registrants was compared to the general NYS behavioral health workforce. Training completion by functional job type was compared to characterize user engagement and preferences. Frequently completed modules were classified by credit and requirement incentives. High initial training engagement across professional role was demonstrated, with significant differences in initial and sustained engagement by professional role. The most frequently completed modules across functional job types contained credit or requirement incentives. The analysis demonstrated that high engagement of a web-based training in a multidisciplinary provider audience can be achieved without tailoring content to specific professional roles. Overlap between frequently completed modules and incentives suggests a role for incentives in promoting engagement of web-based training. These findings further the understanding of strategies to promote large-scale dissemination of evidence-based practice in community behavioral health settings.

Exploring provision of Innovative Community Education Placements (ICEPs) for junior doctors in training: a qualitative study.

PubMed

Griffin, Ann; Jones, Melvyn M; Khan, Nada; Park, Sophie; Rosenthal, Joe; Chrysikou, Vasiliki

2016-02-09

Medical education in community settings is an essential ingredient of doctors' training and a key factor in recruiting general practitioners (GP). Health Education England's report 'Broadening the Foundation' recommends foundation doctors complete 4-month community placements. While Foundation GP schemes exist; other community settings, are not yet used for postgraduate training. The objective of this study was to explore how community-based training of junior doctors might be expanded into possible 'innovative community education placements' (ICEPs), examining opportunities and barriers to these developments. A qualitative study where semistructured interviews were undertaken and themes were generated deductively from the research questions, and iteratively from transcripts. UK community healthcare. Stakeholders from UK Community healthcare providers and undergraduate GP and community educators. Nine participants were interviewed; those experienced in delivering community-based undergraduate education, and others working in community settings that had not previously trained doctors. Themes identified were practicalities such as 'finance and governance', 'communication and interaction', 'delivery of training' and 'perceptions of community'. ICEPs were willing to train Foundation doctors. However, concerns were raised that large numbers and inadequate resources could undermine the quality of educational opportunities, and even cause reputational damage. Organisation was seen as a challenge, which might be best met by placing some responsibility with trainees to manage their placements. ICEP providers agreed that defined service contribution by trainees was required to make placements sustainable, and enhance learning. ICEPs stated the need for positive articulation of the learning value of placements to learners and stakeholders. This study highlighted the opportunities for foundation doctors to gain specialist and generalist knowledge in ICEPs from diverse clinical teams and patients. We recommend in conclusion ways of dealing with some of the perceived barriers to training. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Exploring the General Practitioner-pharmacist relationship in the community setting in Ireland.

PubMed

Moore, Thomas; Kennedy, Julia; McCarthy, Suzanne

2014-10-01

To explore the General Practitioner (GP)-pharmacist relationship, to gain insight into communication between the professions and evaluate opinion on extension of the role of the community pharmacist. A postal questionnaire sent to 500 GPs and 335 community pharmacists with work addresses in the counties of Cork, Kerry, Tipperary, Waterford and Limerick, Ireland. An overall response rate of 56% was achieved. Clear differences of opinion exist between GPs and pharmacists on the extension of the role of the community pharmacist; pharmacist provision of vaccinations (12% of GPs in favour versus 78% of pharmacists), pharmacists prescribing the oral contraceptive pill (18% GP versus 88% pharmacist) and increasing the prescribing power of the pharmacist (37% GP versus 95% pharmacist). Fifty-four percent of GPs and 97% of pharmacists were in favour of pharmacists providing screening services, while 82% of GPs and 96% of pharmacists were in favour of pharmacists dealing with minor ailments. Seventy-three percent of GPs and 43% of pharmacists agreed that communication between the professions was very good. This study identifies a clear difference of opinion on the extension of the role of the community pharmacist and recognises problems in communication between the professions. This comes on the background of continued calls from the Pharmaceutical Society of Ireland for an extension of pharmacist roles and continued opposition from the Irish Medical Organisation to such moves. This study highlights the need for increased dialogue between representative organisations and a commitment for professional agendas to be set aside in the best interests of patients. © 2014 Royal Pharmaceutical Society.

Rapid Bioassessment Methods for Assessing Stream Macroinvertebrate Community on the Savannah River Site

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

Specht, W.L.

Macroinvertebrate sampling was performed at 16 locations in the Savannah River Site (SRS) streams using Hester-Dendy multiplate samplers and EPA Rapid Bioassessment Protocols (RBP). Some of the sampling locations were unimpacted, while other locations had been subject to various forms of perturbation by SRS activities. In general, the data from the Hester-Dendy multiplate samplers were more sensitive at detecting impacts than were the RBP data. We developed a Biotic Index for the Hester-Dendy data which incorporated eight community structure, function, and balance parameters. when tested using a data set that was unrelated to the data set that was used inmore » developing the Biotic Index, the index was very successful at detecting impact.« less

Medical Teaching in Sioux Lookout: Primary Health Care in a Cross-Cultural Setting

PubMed Central

Hagen, Catherine; Casson, Ian; Wilson, Ruth

1989-01-01

When participating in health care in northern Native communities, physician-teachers are challenged to understand community development, treat diverse manifestations of illness and socio-cultural strain, and provide opportunities for students and residents to learn the skills, knowledge, and attitudes that will promote the health of Native people and that will develop the students' own education. The University of Toronto Sioux Lookout Program includes a teaching practice with the goals of service, teaching, and research that provides care and promotes health for 13 000 Ojibway- or Cree-speaking aboriginal Canadians in northwestern Ontario. Knowledge gained in this setting about broad determinants of health, communication skills, and clinical decision making can be generalized to other practices. PMID:21249082

School-Based Clinics That Work.

ERIC Educational Resources Information Center

Public Health Service (DHHS), Rockville, MD.

This paper describes a small set of successful school-based clinics (SBCs) that provide primary health care services for the underserved and identifies factors contributing to their success. Six sites were selected on the basis of three general criteria: (1) direct involvement between the SBC and a federally-funded community health center (CHC);…

Syllabus Design and Construction in Criminal Justice Education.

ERIC Educational Resources Information Center

Culbertson, Robert G.; Carr, Adam F.

Undergraduate course syllabi on law enforcement, courts-law, corrections, and general criminal justice-criminology were assessed, based on 759 usable submissions from 193 junior, community, and senior colleges and universities. Based on the analysis, a set of syllabi to represent the core of a criminal justice curriculum was constructed. Course…

Training Self-Advocacy Skills to Adults with Mild Handicaps.

ERIC Educational Resources Information Center

Sievert, Ann L.; And Others

1988-01-01

Eight mildly handicapped young adults were taught to discriminate whether or not possible violations of legal rights occurred in socially validated scenarios and, if so, to role-play a behavioral sequence to redress rights violations. With one exception, participants demonstrated generalization to four community role-play settings. (JW)

In the Valley of the Giants: Cultivating Intentionality and Integration

ERIC Educational Resources Information Center

Carey, Miriam

2012-01-01

This study examines the cultivation of intentionality and integration in a foundation level General Education class: Communities and Societies. Three research tasks were set within the context of a grounded theoretical approach: codification of indicators for both intentionality and integration, and an examination of student learning logs.…

Metagenomic insights into zooplankton‐associated bacterial communities

PubMed Central

Srivastava, Abhishek; Koski, Marja; Garcia, Juan Antonio L.; Takaki, Yoshihiro; Yokokawa, Taichi; Nunoura, Takuro; Elisabeth, Nathalie H.; Sintes, Eva; Herndl, Gerhard J.

2017-01-01

Summary Zooplankton and microbes play a key role in the ocean's biological cycles by releasing and consuming copious amounts of particulate and dissolved organic matter. Additionally, zooplankton provide a complex microhabitat rich in organic and inorganic nutrients in which bacteria thrive. In this study, we assessed the phylogenetic composition and metabolic potential of microbial communities associated with crustacean zooplankton species collected in the North Atlantic. Using Illumina sequencing of the 16S rRNA gene, we found significant differences between the microbial communities associated with zooplankton and those inhabiting the surrounding seawater. Metagenomic analysis of the zooplankton‐associated microbial community revealed a highly specialized bacterial community able to exploit zooplankton as microhabitat and thus, mediating biogeochemical processes generally underrepresented in the open ocean. The zooplankton‐associated bacterial community is able to colonize the zooplankton's internal and external surfaces using a large set of adhesion mechanisms and to metabolize complex organic compounds released or exuded by the zooplankton such as chitin, taurine and other complex molecules. Moreover, the high number of genes involved in iron and phosphorus metabolisms in the zooplankton‐associated microbiome suggests that this zooplankton‐associated bacterial community mediates specific biogeochemical processes (through the proliferation of specific taxa) that are generally underrepresented in the ambient waters. PMID:28967193

Managing Minor Ailments; The Public's Preferences for Attributes of Community Pharmacies. A Discrete Choice Experiment.

PubMed

Porteous, Terry; Ryan, Mandy; Bond, Christine; Watson, Margaret; Watson, Verity

2016-01-01

Demand for health services continues to rise. Greater use of community pharmacy services instead of medical services for minor ailments could help relieve pressure on healthcare providers in high-cost settings. Community pharmacies are recognised sources of treatment and advice for people wishing to manage these ailments. However, increasing the public's use of pharmacy services may depend on attributes of pharmacies and their staff. This study aimed to determine the general public's relative preferences for community pharmacy attributes using a discrete choice experiment (DCE). A UK-wide DCE survey of the general public was conducted using face-to-face computer-assisted personal interviews. Attributes and levels for the DCE were informed by a literature review and a cohort study of community pharmacy customers. The context for the experiment was a minor ailment scenario describing flu-like symptoms. The DCE choice sets described two hypothetical community pharmacy services; respondents were asked to choose which (if either) of the two pharmacies they would prefer to help them manage symptoms. Data from 1,049 interviews were analysed using an error components logit model. Willingness to pay (WTP), a monetary measure of benefit, was estimated for the different attribute levels. When seeking help or treatment for flu-like symptoms, respondents most valued a pharmacy service that would improve their understanding and management of symptoms (WTP = £6.28), provided by staff who are trained (WTP (pharmacist) = £2.63: WTP(trained assistant) = £3.22), friendly and approachable (WTP = £3.38). Waiting time, pharmacy location and availability of parking also contributed to respondents' preferences. WTP for a service comprising the best possible combination of attributes and levels was calculated as £55.43. Attributes of a community pharmacy and its staff may influence people's decisions about which pharmacy they would visit to access treatment and advice for minor ailments. In line with the public's preferences, offering community pharmacy services that help people to better understand and manage symptoms, are provided promptly by trained staff who are friendly and approachable, and in a local setting with easy access to parking, has the potential to increase uptake amongst those seeking help to manage minor ailments. In this way it may be possible to shift demand away from high-cost health services and make more efficient use of scarce public resources.

[Food consumption and the nutritional status of schoolchildren of the Community of Madrid (CAENPE): general methodology and overall food consumption. Consumo de alimentos y estado nutricional de la población escolar].

PubMed

Vázquez, C; de Cos, A I; Martínez, P; Jaunsolo, M A; Román, E; Gómez, C; López, T; Hernáez, I; Seijas, V; Ramos, V

1995-01-01

The CAENPE study (Food Consumption and Nutritional State of the School Population) was a transversal observational study funded and promoted by the Directorate-General of Food Hygiene in the Ministry of Health, implemented in 1991-93, with the main aim of quantifying food consumption in the school population (6-14 years of age) in the Regional Community of Madrid, together with an anthropometric study and nutritional analysis of that population. This project sets our the General Methodology for the study, paying particular attention to the sampling design, to ensure that the sample is representative of the community, and the results of the overall consumption of food and its comparison with recommended diet and other population studies. Quantification shows a high and rising consumption of meat, meat products, sweets, snacks and prepared dishes, suitable consumption of eggs, legumes and fruit and a notable lack of greens, vegetables and potatoes. The basic results underline the need to introduce educational measures with practical effect on home and school menus.

Berkeley Screen: a set of 96 solutions for general macromolecular crystallization

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

Pereira, Jose H.; McAndrew, Ryan P.; Tomaleri, Giovani P.

Using statistical analysis of the Biological Macromolecular Crystallization Database, combined with previous knowledge about crystallization reagents, a crystallization screen called the Berkeley Screen has been created. Correlating crystallization conditions and high-resolution protein structures, it is possible to better understand the influence that a particular solution has on protein crystal formation. Ions and small molecules such as buffers and precipitants used in crystallization experiments were identified in electron density maps, highlighting the role of these chemicals in protein crystal packing. The Berkeley Screen has been extensively used to crystallize target proteins from the Joint BioEnergy Institute and the Collaborative Crystallography programmore » at the Berkeley Center for Structural Biology, contributing to several Protein Data Bank entries and related publications. The Berkeley Screen provides the crystallographic community with an efficient set of solutions for general macromolecular crystallization trials, offering a valuable alternative to the existing commercially available screens. The Berkeley Screen provides an efficient set of solutions for general macromolecular crystallization trials.« less

Berkeley Screen: a set of 96 solutions for general macromolecular crystallization

DOE PAGES

Pereira, Jose H.; McAndrew, Ryan P.; Tomaleri, Giovani P.; ...

2017-09-05

Using statistical analysis of the Biological Macromolecular Crystallization Database, combined with previous knowledge about crystallization reagents, a crystallization screen called the Berkeley Screen has been created. Correlating crystallization conditions and high-resolution protein structures, it is possible to better understand the influence that a particular solution has on protein crystal formation. Ions and small molecules such as buffers and precipitants used in crystallization experiments were identified in electron density maps, highlighting the role of these chemicals in protein crystal packing. The Berkeley Screen has been extensively used to crystallize target proteins from the Joint BioEnergy Institute and the Collaborative Crystallography programmore » at the Berkeley Center for Structural Biology, contributing to several Protein Data Bank entries and related publications. The Berkeley Screen provides the crystallographic community with an efficient set of solutions for general macromolecular crystallization trials, offering a valuable alternative to the existing commercially available screens. The Berkeley Screen provides an efficient set of solutions for general macromolecular crystallization trials.« less

Impact of dilution on microbial community structure and functional potential: comparison of numerical simulations and batch culture experiments

NASA Technical Reports Server (NTRS)

Franklin, R. B.; Garland, J. L.; Bolster, C. H.; Mills, A. L.

2001-01-01

A series of microcosm experiments was performed using serial dilutions of a sewage microbial community to inoculate a set of batch cultures in sterile sewage. After inoculation, the dilution-defined communities were allowed to regrow for several days and a number of community attributes were measured in the regrown assemblages. Based upon a set of numerical simulations, community structure was expected to differ along the dilution gradient; the greatest differences in structure were anticipated between the undiluted-low-dilution communities and the communities regrown from the very dilute (more than 10(-4)) inocula. Furthermore, some differences were expected among the lower-dilution treatments (e.g., between undiluted and 10(-1)) depending upon the evenness of the original community. In general, each of the procedures used to examine the experimental community structures separated the communities into at least two, often three, distinct groups. The groupings were consistent with the simulated dilution of a mixture of organisms with a very uneven distribution. Significant differences in community structure were detected with genetic (amplified fragment length polymorphism and terminal restriction fragment length polymorphism), physiological (community level physiological profiling), and culture-based (colony morphology on R2A agar) measurements. Along with differences in community structure, differences in community size (acridine orange direct counting), composition (ratio of sewage medium counts to R2A counts, monitoring of each colony morphology across the treatments), and metabolic redundancy (i.e., generalist versus specialist) were also observed, suggesting that the differences in structure and diversity of communities maintained in the same environment can be manifested as differences in community organization and function.

Comparison of macroinvertebrate community structure between two riffle-based sampling protocols in Wyoming, Colorado, and Montana, 2000-2001

USGS Publications Warehouse

Peterson, David A.; Zumberge, Jeremy R.

2006-01-01

Samples of benthic macroinvertebrates were collected side-by-side from riffles at 12 stream sites in Wyoming, Colorado, and Montana during 2000-2001, following protocols established by the U.S. Geological Survey National Water-Quality Assessment (NAWQA) Program and the U.S. Environmental Protection Agency Environmental Monitoring and Assessment Program (EMAP). Samples from riffles were collected following NAWQA protocols, using a sampler with 425-micron net mesh-opening size from a total area of 1.25 m2 per sample in multiple riffles. Samples also were collected following EMAP protocols, using a sampler with 500-micron net mesh-opening size from a total area of 0.72 m2 per sample in multiple riffles. The taxonomic identification and enumeration of the samples followed procedures established for each program. Benthic macroinvertebrate community structure was compared between the data sets using individual metrics, a multimetric index, and multivariate analysis. Comparisons between the macroinvertebrate community structures were made after sequentially adjusting both data sets for: (1) ambiguous taxa, (2) taxonomic inconsistencies, and (3) differences in laboratory subsampling. After removal of ambiguous taxa, pair-wise differences in total taxa richness and Ephemeroptera taxa richness were statistically significant (p < 0.05). Differences between the data sets generally were not significant for richness of other taxa, tolerant taxa, semi-voltine taxa, functional feeding groups, diversity, and dominance. Sample scores calculated using the Wyoming Stream Integrity Index were not significantly different between the two data sets. After reconciling both data sets for taxonomic inconsistencies, total taxa richness and Ephemeroptera taxa richness remained significantly different between the data sets. After adjusting the data for differences in laboratory subsampling, the differences in taxa richness were no longer significant. Bray-Curtis similarity coefficients and non-metric multi-dimensional scaling were used to examine macroinvertebrate community structure. Similarity in community structure between sites was affected to a greater extent by taxa reconciliation than by adjustment for subsampling.

The future: a primary care-led NHS.

PubMed

Cross, Sue

2010-04-01

The NHS is becoming increasingly primary care and community focused and the role of the community nurse is becoming more significant, not just in managing long-term conditions and end of life but in providing vital help and education. Helping people become more knowledgeable about maintaining both their own health and that of their families at home or within the community is vital - the desired end being less need for expensive hospital care. As the demand to implement more complex services grows, so the need for nurses to contribute to the planning and delivery of services becomes more important. Nurses in the community have the experience and practical knowledge and must use it to influence commissioning and engage proactively, and positively, with current policy agendas and with the people whose responsibility it is to implement them. Change in primary care is constant and increasingly it is the frontline deliverers of services that drive that change and help set the agenda. As more care and treatment is devolved from the secondary to primary care setting, there must be greater integration between general practice and the community nursing team, with each helping and informing the other to deliver a world class primary care service.

HIV medication therapy management services in community pharmacies

PubMed Central

Kauffman, Yardlee; Nair, Vidya; Herist, Keith; Thomas, Vasavi; Weidle, Paul J.

2015-01-01

Objectives To present a rationale and a proposed structure to support pharmacist-delivered medication therapy management (MTM) for human immunodeficiency virus (HIV) disease and to outline challenges to implementing and sustaining the service. Data sources Professional literature. Summary Historically, the effect of pharmacy services for HIV-infected persons has been demonstrated in inpatient and clinic-based settings. Developing similar programs adapted for community pharmacists could be a model of care to improve patient adherence to antiretroviral therapy and retention in care. Initiation of antiretroviral therapy and regular monitoring of CD4+ cell count, HIV RNA viral load, adverse drug events, and adherence form the backbone of successful medical management of HIV infection. Support for these services can be provided to HIV-infected patients through pharmacist-managed HIV MTM programs in community pharmacy settings in collaboration with primary providers and other health care professionals. Conclusion Community pharmacists can help meet the growing need for HIV care through provision of MTM services. Although resources have been developed, including the general MTM framework, challenges of adequate training, education, and support of community pharmacists need to be addressed in order for HIV MTM to be a successful model. PMID:23229993

Quality in applied science

NASA Astrophysics Data System (ADS)

Sten, T.

1993-12-01

Science is in many senses a special kind of craft and only skilled craftsmen are able to distinguish good work from bad. Due to the variation in approaches, methods and even philosophical basis, it is nearly impossible to derive a general set of quality criteria for scientific work outside specific research traditions. Applied science introduces a new set of quality criteria having to do with the application of results in practical situations and policy making. A scientist doing basic research relates mainly to the scientific community of which he is a member, while in applied contract research the scientist has to consider the impact of his results both for the immediate users and upon interest groups possibly being affected. Application thus raises a whole new set of requirements having to do with business ethics, policy consequences and societal ethics in general.

A combination of process of care and clinical target among type 2 diabetes mellitus patients in general medical clinics and specialist diabetes clinics at hospital levels.

PubMed

Sieng, Sokha; Hurst, Cameron

2017-08-07

This study compares a combination of processes of care and clinical targets among patients with type 2 diabetes mellitus (T2DM) between specialist diabetes clinics (SDCs) and general medical clinics (GMCs), and how differences between these two types of clinics differ with hospital type (community, provincial and regional). Type 2 diabetes mellitus patient medical records were collected from 595 hospitals (499 community, 70 provincial, 26 regional) in Thailand between April 1 to June 30, 2012 resulting in a cross-sectional sample of 26,860 patients. Generalized linear mixed modeling was conducted to examine associations between clinic type and quality of care. The outcome variables of interest were split into clinical targets and process of care. A subsequent subgroup analysis was conducted to examine if the nature of clinical target and process of care differences between GMCs and SDCs varied with hospital type (regional, provincial, community). Regardless of the types of hospitals (regional, provincial, or community) patients attending SDCs were considerably more likely to have eye and foot exam. In terms of larger hospitals (regional and provincial) patients attending SDCs were more likely to achieve HbA1c exam, All FACE exam, BP target, and the Num7Q. Interestingly, SDCs performed better than GMCs at only provincial hospitals for LDL-C target and the All7Q. Finally, patients with T2DM who attended community hospital-GMCs had a better chance of achieving the blood pressure target than patients who attended community hospital-SDCs. Specialized diabetes clinics outperform general medical clinics for both regional and provincial hospitals for all quality of care indicators and the number of quality of care indicators achieved was never lower. However, this better performance of SDC was not observed in community hospital. Indeed, GMCs outperformed SDCs for some quality of care indicators in the community level setting.

An evaluation of parent-produced video self-modeling to improve independence in an adolescent with intellectual developmental disorder and an autism spectrum disorder: a controlled case study.

PubMed

Allen, Keith D; Vatland, Christopher; Bowen, Scott L; Burke, Raymond V

2015-07-01

We evaluated a parent-created video self-modeling (VSM) intervention to improve independence in an adolescent diagnosed with Intellectual Developmental Disorder (IDD) and Autism Spectrum Disorder (ASD). In a multiple baseline design across routines, a parent and her 17-year-old daughter created self-modeling videos of three targeted routines needed for independence in the community. The parent used a tablet device with a mobile app called "VideoTote" to produce videos of the daughter performing the targeted routines. The mobile app includes a 30-s tutorial about making modeling videos. The parent and daughter produced and watched a VSM scene prior to performing each of the three routines in an analogue community setting. The adolescent showed marked, immediate, and sustained improvements in performing each routine following the production and implementation of the VSM. Performance was found to generalize to the natural community setting. Results suggest that parents can use available technology to promote community independence for transition age individuals. © The Author(s) 2015.

Overlapping Modularity at the Critical Point of k-Clique Percolation

NASA Astrophysics Data System (ADS)

Tóth, Bálint; Vicsek, Tamás; Palla, Gergely

2013-05-01

One of the most remarkable social phenomena is the formation of communities in social networks corresponding to families, friendship circles, work teams, etc. Since people usually belong to several different communities at the same time, the induced overlaps result in an extremely complicated web of the communities themselves. Thus, uncovering the intricate community structure of social networks is a non-trivial task with great potential for practical applications, gaining a notable interest in the recent years. The Clique Percolation Method (CPM) is one of the earliest overlapping community finding methods, which was already used in the analysis of several different social networks. In this approach the communities correspond to k-clique percolation clusters, and the general heuristic for setting the parameters of the method is to tune the system just below the critical point of k-clique percolation. However, this rule is based on simple physical principles and its validity was never subject to quantitative analysis. Here we examine the quality of the partitioning in the vicinity of the critical point using recently introduced overlapping modularity measures. According to our results on real social and other networks, the overlapping modularities show a maximum close to the critical point, justifying the original criteria for the optimal parameter settings.

The bias associated with amplicon sequencing does not affect the quantitative assessment of bacterial community dynamics.

PubMed

Ibarbalz, Federico M; Pérez, María Victoria; Figuerola, Eva L M; Erijman, Leonardo

2014-01-01

The performance of two sets of primers targeting variable regions of the 16S rRNA gene V1-V3 and V4 was compared in their ability to describe changes of bacterial diversity and temporal turnover in full-scale activated sludge. Duplicate sets of high-throughput amplicon sequencing data of the two 16S rRNA regions shared a collection of core taxa that were observed across a series of twelve monthly samples, although the relative abundance of each taxon was substantially different between regions. A case in point was the changes in the relative abundance of filamentous bacteria Thiothrix, which caused a large effect on diversity indices, but only in the V1-V3 data set. Yet the relative abundance of Thiothrix in the amplicon sequencing data from both regions correlated with the estimation of its abundance determined using fluorescence in situ hybridization. In nonmetric multidimensional analysis samples were distributed along the first ordination axis according to the sequenced region rather than according to sample identities. The dynamics of microbial communities indicated that V1-V3 and the V4 regions of the 16S rRNA gene yielded comparable patterns of: 1) the changes occurring within the communities along fixed time intervals, 2) the slow turnover of activated sludge communities and 3) the rate of species replacement calculated from the taxa-time relationships. The temperature was the only operational variable that showed significant correlation with the composition of bacterial communities over time for the sets of data obtained with both pairs of primers. In conclusion, we show that despite the bias introduced by amplicon sequencing, the variable regions V1-V3 and V4 can be confidently used for the quantitative assessment of bacterial community dynamics, and provide a proper qualitative account of general taxa in the community, especially when the data are obtained over a convenient time window rather than at a single time point.

Exploring an increased role for Australian community pharmacy in mental health professional service delivery: evaluation of the literature.

PubMed

Hattingh, H Laetitia; Scahill, Shane; Fowler, Jane L; Wheeler, Amanda J

2016-12-01

Australian general practitioners primarily treat mental health problems by prescribing medication dispensed by community pharmacists. Pharmacists therefore have regular interactions with mental health consumers and carers. This narrative review explored the potential role of community pharmacy in mental health services. Medline, CINAHL, ProQuest, Emerald, PsycINFO, Science Direct, PubMed, Web of Knowledge and IPA were utilised. The Cochrane Library as well as grey literature and "lay" search engines such as GoogleScholar were also searched. Four systematic reviews and ten community pharmacy randomised controlled trials were identified. Various relevant reviews outlining the impact of community pharmacy based disease state or medicines management services were also identified. International studies involving professional service interventions for mental health consumers could be contextualised for the Australian setting. Australian studies of pharmacy professional services for chronic physical health conditions provided further guidance for the expansion of community pharmacy mental health professional services.

The Socialization Research Project. Final Report.

ERIC Educational Resources Information Center

Haring, Thomas G.; And Others

The report documents the findings of a 3-year study of the social skill development of severely handicapped youth within integrated school and community settings. A series of seven studies were instituted on two central issues: (1) the ability to train and promote generalization of social language skills in the form of initiation and respondent…

Summit for the Convention on the Rights of the Child: Mobilizing Communities for Ratification

ERIC Educational Resources Information Center

Brown, Nancy

2006-01-01

In 1989, the United Nations General Assembly adopted the Convention on the Rights of the Child, a comprehensive international children's rights treaty that addresses children's civil, political, economic, social, and cultural rights. The CRC sets goals and standards that promote children's rights, thereby strengthening governmental initiatives to…

Teaching Abduction-Prevention Skills to Children with Autism

ERIC Educational Resources Information Center

Gunby, Kristin V.; Carr, James E.; LeBlanc, Linda A.

2010-01-01

Three children with autism were taught abduction-prevention skills using behavioral skills training with in situ feedback. All children acquired the skills, which were maintained at a 1-month follow-up assessment. In addition, 1 of the children demonstrated the skills during a stimulus generalization probe in a community setting. (Contains 1…

Longitudinal study of infectious intestinal disease in the UK (IID2 study): incidence in the community and presenting to general practice

PubMed Central

Rodrigues, Laura C; Viviani, Laura; Dodds, Julie P; Evans, Meirion R; Hunter, Paul R; Gray, Jim J; Letley, Louise H; Rait, Greta; Tompkins, David S; O'Brien, Sarah J

2011-01-01

Objectives To estimate, overall and by organism, the incidence of infectious intestinal disease (IID) in the community, presenting to general practice (GP) and reported to national surveillance. Design Prospective, community cohort study and prospective study of GP presentation conducted between April 2008 and August 2009. Setting Eighty-eight GPs across the UK recruited from the Medical Research Council General Practice Research Framework and the Primary Care Research Networks. Participants 6836 participants registered with the 88 participating practices in the community study; 991 patients with UK-acquired IID presenting to one of 37 practices taking part in the GP presentation study. Main outcome measures IID rates in the community, presenting to GP and reported to national surveillance, overall and by organism; annual IID cases and GP consultations by organism. Results The overall rate of IID in the community was 274 cases per 1000 person-years (95% CI 254 to 296); the rate of GP consultations was 17.7 per 1000 person-years (95% CI 14.4 to 21.8). There were 147 community cases and 10 GP consultations for every case reported to national surveillance. Norovirus was the most common organism, with incidence rates of 47 community cases per 1000 person-years and 2.1 GP consultations per 1000 person-years. Campylobacter was the most common bacterial pathogen, with a rate of 9.3 cases per 1000 person-years in the community, and 1.3 GP consultations per 1000 person-years. We estimate that there are up to 17 million sporadic, community cases of IID and 1 million GP consultations annually in the UK. Of these, norovirus accounts for 3 million cases and 130 000 GP consultations, and Campylobacter is responsible for 500 000 cases and 80 000 GP consultations. Conclusions IID poses a substantial community and healthcare burden in the UK. Control efforts must focus particularly on reducing the burden due to Campylobacter and enteric viruses. PMID:21708822

Centennial Challenges Program Overview: How NASA Successfully Involves the General Public in the Solving of Current Technology Gaps

NASA Technical Reports Server (NTRS)

Roman, Monsi C.; Kim, Tony; Sudnik, Janet; Sivak, Amy; Porter, Molly; Cylar, Rosaling; Cavanaugh, Dominique; Krome, Kim

2017-01-01

The National Aeronautics and Space Administration (NASA) Centennial Challenges Program, part of the Space Technology Mission Directorate (STMD), addresses key technology needs of NASA and the nation, while facilitating new sources of innovation outside the traditional community. This is done by the direct engagement of the public at large, through the offering of Congressional authorized prize purses and associated challenges developed by NASA and the aerospace community and set up as a competition awarding the prize money for achieving the specified technology goal.

Controlled recovery of phylogenetic communities from an evolutionary model using a network approach

NASA Astrophysics Data System (ADS)

Sousa, Arthur M. Y. R.; Vieira, André P.; Prado, Carmen P. C.; Andrade, Roberto F. S.

2016-04-01

This works reports the use of a complex network approach to produce a phylogenetic classification tree of a simple evolutionary model. This approach has already been used to treat proteomic data of actual extant organisms, but an investigation of its reliability to retrieve a traceable evolutionary history is missing. The used evolutionary model includes key ingredients for the emergence of groups of related organisms by differentiation through random mutations and population growth, but purposefully omits other realistic ingredients that are not strictly necessary to originate an evolutionary history. This choice causes the model to depend only on a small set of parameters, controlling the mutation probability and the population of different species. Our results indicate that for a set of parameter values, the phylogenetic classification produced by the used framework reproduces the actual evolutionary history with a very high average degree of accuracy. This includes parameter values where the species originated by the evolutionary dynamics have modular structures. In the more general context of community identification in complex networks, our model offers a simple setting for evaluating the effects, on the efficiency of community formation and identification, of the underlying dynamics generating the network itself.

An Ethnographic Meta-Synthesis of Three Southwestern Rural Studies.

PubMed

Averill, Jennifer B

2016-01-01

The objectives were to synthesize cumulative findings across three critical ethnographic, community-partnered studies in the southwestern United States and to describe the process of meta-ethnography for that analysis. The meta-ethnography followed the design of Noblit and Hare for constructing an analysis of composite data, informed by community-based participatory research and Stringer's ethnographic strategies of Look-Think-Act. The three studies occurred in rural settings of Colorado and New Mexico, engaging 129 total participants, along with community organizations and agencies as partners. Methods consisted of detailed review of each original study, mapping of major concepts and themes, and general analysis, interpretation, and synthesis across the studies. Overall themes were: health is the capacity to care for oneself and do work, meaningful relationships are key in health care interactions, patterns of discrimination persist in rural settings, poor literacy and health literacy are barriers, and food insecurity is a growing concern for older rural adults. Resolutions involve practice, policy, and research and must incorporate all stakeholder groups in rural settings; a participatory approach is critical to prioritize and impact existing inequities; and work is needed to extend education and understanding of multiple cultures, groups, customs, and rural contexts. © 2015 Wiley Periodicals, Inc.

Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis

PubMed Central

Rich, Josiah D; Beckwith, Curt G; Macmadu, Alexandria; Marshall, Brandon D L; Brinkley-Rubinstein, Lauren; Amon, Joseph J; Milloy, M-J; King, Maximilian R F; Sanchez, Jorge; Atwoli, Lukoye; Altice, Frederick L

2017-01-01

The burden of HIV/AIDS and other transmissible diseases is higher in prison and jail settings than in the non-incarcerated communities that surround them. In this comprehensive review, we discuss available literature on the topic of clinical management of people infected with HIV, hepatitis B and C viruses, and tuberculosis in incarcerated settings in addition to co-occurrence of one or more of these infections. Methods such as screening practices and provision of treatment during detainment periods are reviewed to identify the effect of community-based treatment when returning inmates into the general population. Where data are available, we describe differences in the provision of medical care in the prison and jail settings of low-income and middle-income countries compared with high-income countries. Structural barriers impede the optimal delivery of clinical care for prisoners, and substance use, mental illness, and infectious disease further complicate the delivery of care. For prison health care to reach the standards of community-based health care, political will and financial investment are required from governmental, medical, and humanitarian organisations worldwide. In this review, we highlight challenges, gaps in knowledge, and priorities for future research to improve health-care in institutions for prisoners. PMID:27427452

A BEME systematic review of UK undergraduate medical education in the general practice setting: BEME Guide No. 32.

PubMed

Park, Sophie; Khan, Nada F; Hampshire, Mandy; Knox, Richard; Malpass, Alice; Thomas, James; Anagnostelis, Betsy; Newman, Mark; Bower, Peter; Rosenthal, Joe; Murray, Elizabeth; Iliffe, Steve; Heneghan, Carl; Band, Amanda; Georgieva, Zoya

2015-05-06

General practice is increasingly used as a learning environment in undergraduate medical education in the UK. The aim of this project was to identify, summarise and synthesise research about undergraduate medical education in general practice in the UK. We systematically identified studies of undergraduate medical education within a general practice setting in the UK from 1990 onwards. All papers were summarised in a descriptive report and categorised into two in-depth syntheses: a quantitative and a qualitative in-depth review. 169 papers were identified, representing research from 26 UK medical schools. The in-depth review of quantitative papers (n = 7) showed that medical students learned clinical skills as well or better in general practice settings. Students receive more teaching, and clerk and examine more patients in the general practice setting than in hospital. Patient satisfaction and enablement are similar whether a student is present or not in a consultation, however, patients experience lower relational empathy. Two main thematic groups emerged from the qualitative in-depth review (n = 10): the interpersonal interactions within the teaching consultation and the socio-cultural spaces of learning which shape these interactions. The GP has a role as a broker of the interactions between patients and students. General practice is a socio-cultural and developmental learning space for students, who need to negotiate the competing cultures between hospital and general practice. Lastly, patients are transient members of the learning community, and their role requires careful facilitation. General practice is as good, if not better, than hospital delivery of teaching of clinical skills. Our meta-ethnography has produced rich understandings of the complex relationships shaping possibilities for student and patient active participation in learning.

Community structure from spectral properties in complex networks

NASA Astrophysics Data System (ADS)

Servedio, V. D. P.; Colaiori, F.; Capocci, A.; Caldarelli, G.

2005-06-01

We analyze the spectral properties of complex networks focusing on their relation to the community structure, and develop an algorithm based on correlations among components of different eigenvectors. The algorithm applies to general weighted networks, and, in a suitably modified version, to the case of directed networks. Our method allows to correctly detect communities in sharply partitioned graphs, however it is useful to the analysis of more complex networks, without a well defined cluster structure, as social and information networks. As an example, we test the algorithm on a large scale data-set from a psychological experiment of free word association, where it proves to be successful both in clustering words, and in uncovering mental association patterns.

Panel Discussion: Common Themes Across ``Bringing Newcomers Into The Physics Community''

NASA Astrophysics Data System (ADS)

Little, Angela

2014-03-01

I will be facilitating a discussion between the audience and the four speakers in this session: Dimitri Dounas-Frazer, Catherine Good, Casey Miller, and Katie Hinko. They will all be speaking on the same general topic of supporting newcomers to the physics community at critical transition points but come from a set of diverse contexts and perspectives. Their work spans a wide age range of STEM students and they approach their work through many different lenses: as physics faculty, program directors, education and psychology researchers, and combinations thereof. Broad themes across these contexts and perspectives will be explored such as the role of growth mindset, community, and professional development.

School and community relations in North America: Creative tensions

NASA Astrophysics Data System (ADS)

Loughran, E.; Reed, H. B.

1980-09-01

School and community relations in North America reflect creative tensions between the conserving forces of schooling and the changing forces of community. During crisis periods community development needs may modify the school's focus on individual learner growth, but generally schools use the community to extend and enrich the traditional modes. School and community interactions are chiefly characterized by such settings as community schools, community education, adult education, home and school (PTA) associations, work-study programs, curriculum-community resource programs. Recent social forces are creating heightened tensions: cultural pluralism, reduced resources, Third World influences, international conflicts, personal alienation, population concerns, energy problems, community power issues. These forces are gradually shifting school and community concepts towards ones of education and community. Education goes well beyond schooling, including all agencies having an organized influence on community development: libraries, voluntary groups, unions, business, human service agencies, government units, as well as schools. This shift requires research to develop nonformal concepts and practices, along with formal pedagogy, to increase the positive impacts of educational networks on community, as well as individual, development. These new directions have not yet significantly modified the traditional meaning of school and community relations.

Community and facility-level engagement in planning and budgeting for the government health sector--a district perspective from Kenya.

PubMed

O'Meara, Wendy Prudhomme; Tsofa, Benjamin; Molyneux, Sassy; Goodman, Catherine; McKenzie, F Ellis

2011-03-01

Health systems reform processes have increasingly recognized the essential contribution of communities to the success of health programs and development activities in general. Here we examine the experience from Kilifi district in Kenya of implementing annual health sector planning guidelines that included community participation in problem identification, priority setting, and planning. We describe challenges in the implementation of national planning guidelines, how these were met, and how they influenced final plans and budgets. The broad-based community engagement envisaged in the guidelines did not take place due to the delay in roll out of the Ministry of Health-trained community health workers. Instead, community engagement was conducted through facility management committees, though in a minority of facilities, even such committees were not involved. Some overlap was found in the priorities highlighted by facility staff, committee members and national indicators, but there were also many additional issues raised by committee members and not by other groups. The engagement of the community through committees influenced target and priority setting, but the emphasis on national health indicators left many local priorities unaddressed by the final work plans. Moreover, it appears that the final impact on budgets allocated at district and facility level was limited. The experience in Kilifi highlights the feasibility of engaging the community in the health planning process, and the challenges of ensuring that this engagement feeds into consolidated plans and future implementation. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Assessing Community Quality of Health Care.

PubMed

Herrin, Jeph; Kenward, Kevin; Joshi, Maulik S; Audet, Anne-Marie J; Hines, Stephen J

2016-02-01

To determine the agreement of measures of care in different settings-hospitals, nursing homes (NHs), and home health agencies (HHAs)-and identify communities with high-quality care in all settings. Publicly available quality measures for hospitals, NHs, and HHAs, linked to hospital service areas (HSAs). We constructed composite quality measures for hospitals, HHAs, and nursing homes. We used these measures to identify HSAs with exceptionally high- or low-quality of care across all settings, or only high hospital quality, and compared these with respect to sociodemographic and health system factors. We identified three dimensions of hospital quality, four HHA dimensions, and two NH dimensions; these were poorly correlated across the three care settings. HSAs that ranked high on all dimensions had more general practitioners per capita, and fewer specialists per capita, than HSAs that ranked highly on only the hospital measures. Higher quality hospital, HHA, and NH care are not correlated at the regional level; regions where all dimensions of care are high differ systematically from regions which score well on only hospital measures and from those which score well on none. © Health Research and Educational Trust.

Community engagement strategies for genomic studies in Africa: a review of the literature.

PubMed

Tindana, Paulina; de Vries, Jantina; Campbell, Megan; Littler, Katherine; Seeley, Janet; Marshall, Patricia; Troyer, Jennifer; Ogundipe, Morisola; Alibu, Vincent Pius; Yakubu, Aminu; Parker, Michael

2015-04-12

Community engagement has been recognised as an important aspect of the ethical conduct of biomedical research, especially when research is focused on ethnically or culturally distinct populations. While this is a generally accepted tenet of biomedical research, it is unclear what components are necessary for effective community engagement, particularly in the context of genomic research in Africa. We conducted a review of the published literature to identify the community engagement strategies that can support the successful implementation of genomic studies in Africa. Our search strategy involved using online databases, Pubmed (National Library of Medicine), Medline and Google scholar. Search terms included a combination of the following: community engagement, community advisory boards, community consultation, community participation, effectiveness, genetic and genomic research, Africa, developing countries. A total of 44 articles and 1 thesis were retrieved of which 38 met the selection criteria. Of these, 21 were primary studies on community engagement, while the rest were secondary reports on community engagement efforts in biomedical research studies. 34 related to biomedical research generally, while 4 were specific to genetic and genomic research in Africa. We concluded that there were several community engagement strategies that could support genomic studies in Africa. While many of the strategies could support the early stages of a research project such as the recruitment of research participants, further research is needed to identify effective strategies to engage research participants and their communities beyond the participant recruitment stage. Research is also needed to address how the views of local communities should be incorporated into future uses of human biological samples. Finally, studies evaluating the impact of CE on genetic research are lacking. Systematic evaluation of CE strategies is essential to determine the most effective models of CE for genetic and genomic research conducted in African settings.

Adaptive bleaching: A general phenomenon

USGS Publications Warehouse

Fautin, D.G.; Buddemeier, R.W.

2004-01-01

Laboratory and field data bearing on the adaptive bleaching hypothesis (ABH) are largely consistent with it; no data of which we are aware refute it. We generalize the ABH in light of these data and observations. The population of zooxanthellae within an organism is dynamic, the diversity of zooxanthellae is both surprising and difficult to ascertain, and field experiments demonstrate both turn-over in zooxanthella types and habitat-holobiont correlations. Dynamic change in symbiont communities, and the idea of an equilibrium or optimal community that matches the environment at a particular place and time, are concepts that underlie or emerge from much of the recent literature. The mechanism we proposed to explain responses to acute bleaching appears to operate continuously, thereby enabling the host-symbiont holobiont to track even subtle environmental changes and respond promptly to them. These findings enhance the potential importance of the ABH in the outcomes of acute bleaching, which can (1) accelerate this process of holobiont change, and (2) change the set of possible trajectories for how symbiont communities might recover.

The Clock Drawing Test versus Mini-mental Status Examination as a Screening Tool for Dementia: A Clinical Comparison

PubMed Central

Palsetia, Delnaz; Rao, G. Prasad; Tiwari, Sarvada C.; Lodha, Pragya; De Sousa, Avinash

2018-01-01

There is a growing incidence of dementia patients in the community, and with this growth, there is need for rapid, valid, and easily administrable tests for the screening of dementia and mild cognitive impairment in the community. This review looks at the two most commonly used tests in dementia screening, namely, the clock drawing test (CDT) and the mini-mental status examination (MMSE). Both these tests have been used in dementia screening over the past three decades and have been the subject of scrutiny of various studies, reviews, and meta-analysis. Both these tests are analyzed on their ability to assess dementia and screen for it in the community, general practice and general hospital settings. The methods of administration and scoring of each test are discussed, and their advantages and disadvantages are explained. There is also a direct comparison made between the MMSE and CDT in dementia screening. Future research needs with these tests are also elucidated. PMID:29403122

Approximate correlations for chevron-type plate heat exchangers

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

Wanniarachchi, A.S.; Ratnam, U.; Tilton, B.E.

1995-12-31

There exists very little useful data representing the performance of industrial plate heat exchangers (PHEs) in the open literature. As a result, it has been difficult to arrive at any generalized correlations. While every PHE manufacturer is believed to have a comprehensive set of performance curves for their own designs, there exists the need to generate an approximate set of generalized correlations for the heat-transfer community. Such correlations can be used for preliminary designs and analytical studies. This paper attempts to develop such a set of generalized correlations to quantify the heat-transfer and pressure-drop performance of chevron-type PHEs. For thismore » purpose, the experimental data reported by Heavner et al. were used for the turbulent region. For the laminar region, a semi-theoretical approach was used to express, for example, the friction factor as a function of the Reynolds number and the chevron angle. Asymptotic curves were used for the transitional region. Physical explanations are provided for the trends shown by the generalized correlations. The correlations are compared against the open-literature data, where appropriate. These correlations are expected to be improved in the future when more data become available.« less

Cognitive Style and Self-Efficacy: Predicting Student Success in Online Distance Education

ERIC Educational Resources Information Center

DeTure, Monica

2004-01-01

This study was designed to identify those learner attributes that may be used to predict student success (in terms of grade point average) in a Web-based distance education setting. Students enrolled in six Web-based, general education distance education courses at a community college were asked to complete the Group Embedded Figures Test for…

Risk terminology primer: Basic principles and a glossary for the wildland fire management community

Treesearch

Matthew P. Thompson; Tom Zimmerman; Dan Mindar; Mary Taber

2016-01-01

Risk management is being increasingly promoted as an appropriate method for addressing wildland fire management challenges. However, a lack of a common understanding of risk concepts and terminology is hindering effective application. In response, this General Technical Report provides a set of clear, consistent, understandable, and usable definitions for terms...

Using Evaluation to Effect Social Change: Looking through a Community Psychology Lens

ERIC Educational Resources Information Center

Cook, James R.

2015-01-01

Program evaluation is generally viewed as a set of mechanisms for collecting and using information to learn about projects, policies and programs, to understand their effects as well as the manner in which they are implemented. AEA has espoused principles for evaluation that place emphasis on competent, honest inquiry that respects the security,…

Comparison of cigarette smoking knowledge, attitudes, and practices among staff in perinatal and other substance abuse treatment settings.

PubMed

Miller-Thomas, Tonya; Leoutsakos, Jeannie-Marie S; Terplan, Mishka; Brigham, Emily P; Chisolm, Margaret S

2014-01-01

Despite the high prevalence and known morbidity and mortality caused by cigarette smoking, 60% to 70% of substance abuse treatment programs lack smoking cessation counseling or fail to offer pharmacotherapy for smoking cessation, including those programs designed to meet the needs of drug-dependent pregnant patients. Previous studies of staff knowledge, attitudes, and practices (S-KAP) at general substance abuse/HIV treatment programs have suggested that staff may contribute to the deficiency in smoking cessation treatment in these settings. It is not known whether similar deficiencies exist at perinatal substance abuse treatment programs. This study compared cigarette S-KAP in perinatal substance abuse (n = 41) and general substance abuse/HIV treatment (Veterans Affairs [VA] medical center, hospital-, and community-based) workforce samples (n = 335). Significant differences were seen between the 2 groups on all measures, but perinatal staff compared favorably to general staff only on measures of barriers to smoking cessation services. Perinatal staff compared unfavorably on all other measures: knowledge, beliefs/attitudes, self-efficacy, and smoking cessation practices. Pair-wise comparisons of knowledge and beliefs/attitudes revealed a significant difference between perinatal and VA staff; of self-efficacy, between perinatal and staff at all other settings; and of smoking cessation practices, between perinatal and VA and community-based staff. These results-showing deficiencies of perinatal staff on most S-KAP measures-are concerning and suggest that identifying gaps in and improving S-KAP in perinatal substance abuse programs is urgently needed, for which the VA may provide an efficacious model.

What constitutes an effective community pharmacy?--development of a preliminary model of organizational effectiveness through concept mapping with multiple stakeholders.

PubMed

Scahill, S L; Harrison, J; Carswell, P

2010-08-01

To develop a multi-constituent model of organizational effectiveness for community pharmacy. Using Concept Systems software, a project with 14 stakeholders included a three stage process: (i) face to face brainstorming to generate statements describing what constitutes an effective community pharmacy, followed by (ii) statement reduction and approval by participants, followed by (iii) sorting of the statements into themes with rating of each statement for importance. Primary care in a government-funded, national health care system. A multi-constituent group representing policy-makers and health care providers including; community pharmacy, professional pharmacy organizations, primary health care funders and policy-makers, general practitioners and general practice support organizations. Statement clusters included: 'has safe and effective workflows', 'contributes to the safe use of medicines', 'manages human resources and has leadership', 'has a community focus', 'is integrated within primary care', 'is a respected innovator', 'provides health promotion and preventative care', 'communicates and advocates'. These clusters fit into a quadrant model setting stakeholder focus against role development. The poles of stakeholder focus are 'internal capacity' and 'social utility'. The poles of role development are labelled 'traditional safety roles' and 'integration and innovation'. Organizational effectiveness in community pharmacy includes the internal and external focus of the organization and role development. Our preliminary model describes an effective community pharmacy and provides a platform for investigation of the factors that may influence the organizational effectiveness of individual community pharmacies now and into the future.

Improving the prescribing of antibiotics for urinary tract infection.

PubMed

Peterson, G M; Stanton, L A; Bergin, J K; Chapman, G A

1997-04-01

In recent years there have been changes in the recommended antibiotic treatment for urinary tract infections (UTIs). In particular, the use of amoxycillin or co-trimoxazole is now discouraged, with amoxycillin-potassium clavulanate, cephalexin and trimethoprim becoming first-line agents for uncomplicated lower UTIs. To examine whether academic detailing, performed by a pharmacist, could modify prescribing practices for antibiotics used in the treatment of UTI in the community setting. The intervention was conducted in Southern Tasmania, using the remainder of the State as a control area. The target group of general practitioners was sent educational material designed to assist in the appropriate prescribing of antibiotics in the treatment of UTI. A pharmacist then visited each general practitioner and discussed the rational use of antibiotics for UTIs directly with him/her. Outcomes were measured using evaluation feedback from the general practitioners and pharmacoepidemiological data, which were not linked to diagnosis. The key variable examined was the total defined daily doses (DDDs) dispensed for the recommended first-line agents (amoxycillin-potassium clavulanate, cephalexin and trimethoprim) compared with amoxycillin (3 g single-dose form) and co-trimoxazole. The educational programme was very well received by the general practitioners. Changes in the prescribing of antibiotics commonly used for UTIs were evident in both study regions over the course of the study, but the improvements were significantly greater in the intervention area. Educational programmes utilizing academic detailing by pharmacists can modify prescribing practices within the community setting.

Managing Minor Ailments; The Public’s Preferences for Attributes of Community Pharmacies. A Discrete Choice Experiment

PubMed Central

Ryan, Mandy; Bond, Christine; Watson, Margaret

2016-01-01

Background Demand for health services continues to rise. Greater use of community pharmacy services instead of medical services for minor ailments could help relieve pressure on healthcare providers in high-cost settings. Community pharmacies are recognised sources of treatment and advice for people wishing to manage these ailments. However, increasing the public’s use of pharmacy services may depend on attributes of pharmacies and their staff. This study aimed to determine the general public’s relative preferences for community pharmacy attributes using a discrete choice experiment (DCE). Method A UK-wide DCE survey of the general public was conducted using face-to-face computer-assisted personal interviews. Attributes and levels for the DCE were informed by a literature review and a cohort study of community pharmacy customers. The context for the experiment was a minor ailment scenario describing flu-like symptoms. The DCE choice sets described two hypothetical community pharmacy services; respondents were asked to choose which (if either) of the two pharmacies they would prefer to help them manage symptoms. Data from 1,049 interviews were analysed using an error components logit model. Willingness to pay (WTP), a monetary measure of benefit, was estimated for the different attribute levels. Results When seeking help or treatment for flu-like symptoms, respondents most valued a pharmacy service that would improve their understanding and management of symptoms (WTP = £6.28), provided by staff who are trained (WTP (pharmacist) = £2.63: WTP(trained assistant) = £3.22), friendly and approachable (WTP = £3.38). Waiting time, pharmacy location and availability of parking also contributed to respondents’ preferences. WTP for a service comprising the best possible combination of attributes and levels was calculated as £55.43. Conclusion Attributes of a community pharmacy and its staff may influence people’s decisions about which pharmacy they would visit to access treatment and advice for minor ailments. In line with the public’s preferences, offering community pharmacy services that help people to better understand and manage symptoms, are provided promptly by trained staff who are friendly and approachable, and in a local setting with easy access to parking, has the potential to increase uptake amongst those seeking help to manage minor ailments. In this way it may be possible to shift demand away from high-cost health services and make more efficient use of scarce public resources. PMID:27031588

Using Community Partnerships to Better Understand the Barriers to Using an Evidence-Based, Parent-Mediated Intervention for Autism Spectrum Disorder in a Medicaid System.

PubMed

Pickard, Katherine E; Kilgore, Amanda N; Ingersoll, Brooke R

2016-06-01

Service use disparities have been noted to impede under-resourced families' ability to access high-quality services for their child with autism spectrum disorder (ASD). These disparities are particularly relevant for parent-mediated interventions and may suggest a lack of fit between these interventions and the needs of under-resourced community settings. This study used Roger's Diffusion of Innovations theory to guide community partnerships aimed at understanding the perceived compatibility, complexity, and relative advantage of using an evidence-based, parent-mediated intervention (Project ImPACT) within a Medicaid system. Three focus groups were conducted with 16 Medicaid-eligible parents, and three focus groups were conducted with 16 ASD providers operating within a Medicaid system. Across all groups, parents and providers reported general interest in using Project ImPACT. However, primary themes emerged regarding the need to (a) reduce the complexity of written materials; (b) allow for a more flexible program delivery; (c) ensure a strong parent-therapist alliance; (d) involve the extended family; and (e) help families practice the intervention within their preexisting routines. Results are discussed as they relate to the design and fit of evidence-based, parent-mediated interventions for under-resourced community settings. © Society for Community Research and Action 2016.

A Community Based Systems Diagram of Obesity Causes.

PubMed

Allender, Steven; Owen, Brynle; Kuhlberg, Jill; Lowe, Janette; Nagorcka-Smith, Phoebe; Whelan, Jill; Bell, Colin

2015-01-01

Application of system thinking to the development, implementation and evaluation of childhood obesity prevention efforts represents the cutting edge of community-based prevention. We report on an approach to developing a system oriented community perspective on the causes of obesity. Group model building sessions were conducted in a rural Australian community to address increasing childhood obesity. Stakeholders (n = 12) built a community model that progressed from connection circles to causal loop diagrams using scripts from the system dynamics literature. Participants began this work in identifying change over time in causes and effects of childhood obesity within their community. The initial causal loop diagram was then reviewed and elaborated by 50 community leaders over a full day session. The process created a causal loop diagram representing community perceptions of determinants and causes of obesity. The causal loop diagram can be broken down into four separate domains; social influences; fast food and junk food; participation in sport; and general physical activity. This causal loop diagram can provide the basis for community led planning of a prevention response that engages with multiple levels of existing settings and systems.

Predicting community composition from pairwise interactions

NASA Astrophysics Data System (ADS)

Friedman, Jonathan; Higgins, Logan; Gore, Jeff

The ability to predict the structure of complex, multispecies communities is crucial for understanding the impact of species extinction and invasion on natural communities, as well as for engineering novel, synthetic communities. Communities are often modeled using phenomenological models, such as the classical generalized Lotka-Volterra (gLV) model. While a lot of our intuition comes from such models, their predictive power has rarely been tested experimentally. To directly assess the predictive power of this approach, we constructed synthetic communities comprised of up to 8 soil bacteria. We measured the outcome of competition between all species pairs, and used these measurements to predict the composition of communities composed of more than 2 species. The pairwise competitions resulted in a diverse set of outcomes, including coexistence, exclusion, and bistability, and displayed evidence for both interference and facilitation. Most pair outcomes could be captured by the gLV framework, and the composition of multispecies communities could be predicted for communities composed solely of such pairs. Our results demonstrate the predictive ability and utility of simple phenomenology, which enables accurate predictions in the absence of mechanistic details.

Putting sex education in its place.

PubMed

Cassell, C

1981-04-01

In order to help reduce fears and anxieties regarding the influence of sex education in a public school setting, school and community sexuality educators need to better articulate the difference between formal and structured sex education and non-formal, informal and incidental sex learning. Sex education is only 1 aspect of the sexual learning process. 2 main points have to be clarified for parents and the general public to set the stage for a new way to view the school and community involvement in the sexual learning process: the schools' sexuality education courses constitute only a small portion of the sexual learning process; and sexual learning is not an event for youth only, but a process spanning life. Sex education (the process) connotates an academic setting with a specific curricula taught by a trained instructor, but sexual learning relates to environmental, non-formal incidental learning from a multitude of sources. Studies indicate that teenagers receive about 90% of their contraceptive and sexuality informaation from peers and mass media and that these sources of information are becoming their preferred sources of sex education. What is needed is a way to address and improve the conditions of sexual learning in the community. As home is the ideal environment for primary and positive sexual learning, parents need support in their role as sex educators. Classroom sexuality education curricula in all school settings have a solid place in the process of sexual learning.

Partners in Science: A Suggested Framework for Inclusive Research

NASA Astrophysics Data System (ADS)

Pandya, R. E.

2012-12-01

Public participation in scientific research, also known as citizen science, is effective on many levels: it produces sound, publishable science and data, helps participants gain scientific knowledge and learn about the methods and practices of modern science, and can help communities advance their own priorities. Unfortunately, the demographics of citizen science programs do not reflect the demographics of the US; in general people of color and less affluent members of society are under-represented. To understand the reasons for this disparity, it is useful to look to the broader research about participation in science in a variety of informal and formal settings. From this research, the causes for unequal participation in science can be grouped into three broad categories: accessibility challenges, cultural differences, and a gap between scientific goals and community priorities. Many of these challenges are addressed in working with communities to develop an integrated program of scientific research, education, and community action that addresses community priorities and invites community participation at every stage of the process from defining the question to applying the results. In the spectrum of ways to engage the public in scientific research, this approach of "co-creation" is the most intensive. This talk will explore several examples of co-creation of science, including collaborations with tribal communities around climate change adaptation, work in the Louisiana Delta concerning land loss, and the link between weather and disease in Africa. We will articulate some of the challenges of working this intensively with communities, and suggest a general framework for guiding this kind of work with communities. This model of intensive collaboration at every stage is a promising one for adding to the diversity of citizen science efforts. It also provides a powerful strategy for science more generally, and may help us diversify our field, ensure the use and usability of our science, and help strengthen public support for and acceptance of scientific results.

Standardizing electrofishing power for boat electrofishing: chapter 14

USGS Publications Warehouse

Miranda, L.E. (Steve); Bonar, Scott A.; Hubert, Wayne A.; Willis, David W.

2009-01-01

Standardizing boat electrofishing entails achieving an accepted level of collection consistency by managing various brand factors, including (1) the temporal and spatial distribution of sampling effort, (2) boat operation, (3) equipment configuration, (4) characteristics of the waveform and energized field, and (5) power transferred to fish. This chapter focuses exclusively on factor 5:L factors 1-4 have been addressed in earlier chapters. Additionally, while the concepts covered in this chapter address boat electrofishing in general, the power settings discussed were developed from tests with primarily warmwater fish communities. Others (see Chapter 9) recommend lower power settings for communities consisting of primarily coldwater fishes. For reviews of basic concepts of electricity, electrofishing theory and systems, fish behavior relative to diverse waveforms, and injury matter, the reader is referred to Novotny (1990), Reynold (1996), and Snyder (2003).

Loyalty in Online Communities.

PubMed

Hamilton, William L; Zhang, Justine; Danescu-Niculescu-Mizil, Cristian; Jurafsky, Dan; Leskovec, Jure

2017-05-01

Loyalty is an essential component of multi-community engagement. When users have the choice to engage with a variety of different communities, they often become loyal to just one, focusing on that community at the expense of others. However, it is unclear how loyalty is manifested in user behavior, or whether certain community characteristics encourage loyalty. In this paper we operationalize loyalty as a user-community relation: users loyal to a community consistently prefer it over all others; loyal communities retain their loyal users over time. By exploring a large set of Reddit communities, we reveal that loyalty is manifested in remarkably consistent behaviors. Loyal users employ language that signals collective identity and engage with more esoteric, less popular content, indicating that they may play a curational role in surfacing new material. Loyal communities have denser user-user interaction networks and lower rates of triadic closure, suggesting that community-level loyalty is associated with more cohesive interactions and less fragmentation into subgroups. We exploit these general patterns to predict future rates of loyalty. Our results show that a user's propensity to become loyal is apparent from their initial interactions with a community, suggesting that some users are intrinsically loyal from the very beginning.

Loyalty in Online Communities

PubMed Central

Hamilton, William L.; Zhang, Justine; Danescu-Niculescu-Mizil, Cristian; Jurafsky, Dan; Leskovec, Jure

2018-01-01

Loyalty is an essential component of multi-community engagement. When users have the choice to engage with a variety of different communities, they often become loyal to just one, focusing on that community at the expense of others. However, it is unclear how loyalty is manifested in user behavior, or whether certain community characteristics encourage loyalty. In this paper we operationalize loyalty as a user-community relation: users loyal to a community consistently prefer it over all others; loyal communities retain their loyal users over time. By exploring a large set of Reddit communities, we reveal that loyalty is manifested in remarkably consistent behaviors. Loyal users employ language that signals collective identity and engage with more esoteric, less popular content, indicating that they may play a curational role in surfacing new material. Loyal communities have denser user-user interaction networks and lower rates of triadic closure, suggesting that community-level loyalty is associated with more cohesive interactions and less fragmentation into subgroups. We exploit these general patterns to predict future rates of loyalty. Our results show that a user’s propensity to become loyal is apparent from their initial interactions with a community, suggesting that some users are intrinsically loyal from the very beginning. PMID:29354326

Students learning medicine in general practice in Canada and Australia.

PubMed

Strasser, Roger

2016-01-01

Over the past 20 years, there has been increasing focus on general practice and the role of general practitioners (GPs) in undergraduate medical education. This article explores the experiences in Australia and Canada of students learning medicine in the general practice setting, drawing on general practice and medical education literature in both countries and beyond. In Canada and Australia, there is substantial and growing evidence that students learning medicine in general practice has positive value for all involved, including the students, patients, wider community, academic institutions and GPs. The space, time and financial aspects of GP-based medical education require further study. Nevertheless, there is considerable potential to develop and implement a national plan for GP-based medical education with targeted government investment and commitment from academic institutions.

Unexpected Diversity during Community Succession in the Apple Flower Microbiome

PubMed Central

Shade, Ashley; McManus, Patricia S.; Handelsman, Jo

2013-01-01

ABSTRACT Despite its importance to the host, the flower microbiome is poorly understood. We report a culture-independent, community-level assessment of apple flower microbial diversity and dynamics. We collected flowers from six apple trees at five time points, starting before flowers opened and ending at petal fall. We applied streptomycin to half of the trees when flowers opened. Assessment of microbial diversity using tag pyrosequencing of 16S rRNA genes revealed that the apple flower communities were rich and diverse and dominated by members of TM7 and Deinococcus-Thermus, phyla about which relatively little is known. From thousands of taxa, we identified six successional groups with coherent dynamics whose abundances peaked at different times before and after bud opening. We designated the groups Pioneer, Early, Mid, Late, Climax, and Generalist communities. The successional pattern was attributed to a set of prevalent taxa that were persistent and gradually changing in abundance. These taxa had significant associations with other community members, as demonstrated with a cooccurrence network based on local similarity analysis. We also detected a set of less-abundant, transient taxa that contributed to general tree-to-tree variability but not to the successional pattern. Communities on trees sprayed with streptomycin had slightly lower phylogenetic diversity than those on unsprayed trees but did not differ in structure or succession. Our results suggest that changes in apple flower microbial community structure are predictable over the life of the flower, providing a basis for ecological understanding and disease management. PMID:23443006

Perceived current needs, psychological distress and functional impairment in a war-affected setting: a cross-sectional study in South Sudan.

PubMed

Ayazi, Touraj; Swartz, Leslie; Eide, Arne H; Lien, Lars; Hauff, Edvard

2015-08-19

To examine the current perceived needs of the general population in a war-affected setting, and to study the influence of perceived needs on the participants' mental health status and functional impairment across genders. A cross-sectional community survey (n=464) was conducted in war-affected South Sudan. Three regression models were analysed. Perceived needs were assessed with the Humanitarian Emergency Settings Perceived Needs Scale. Psychological distress was measured with the General Health Questionnaire and level of functioning by the Short Form Health Survey (SF-12). The most frequently expressed needs were related to drinking water, alcohol and drug use in the community and access to sanitation facilities. No gender differences were found regarding the level of perceived needs or the number of traumatic events. Higher level of perceived needs significantly predicted psychological distress and lower level of functioning even when numbers of experienced trauma events were taken into account. The associations of higher level of needs and trauma experiences, on the one hand, and negative health outcomes on the other, necessitate a greater integration of interventions directed towards the population's perceived needs and mental health, particularly for those who have been exposed to trauma. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Qualitative interviews regarding pharmacist prescribing in the community setting.

PubMed

Feehan, Michael; Durante, Richard; Ruble, Jim; Munger, Mark A

2016-09-15

The perceived demand for and barriers to pharmacist prescribing in the community pharmacy setting were studied. Qualitative interviews were conducted with 19 consumers, 20 community pharmacists, and 8 reimbursement decision-makers from payer organizations between April and June 2015. Respondents were invited to participate in a daylong interview process online. Interviews with consumers and pharmacists were conducted using online bulletin board technology. Telephone interviews were conducted with reimbursement decision-makers. As with all qualitative research, the sample sizes used were restrictive and sufficient to gauge the perceptions of those respondents only. Interview responses were not intended to be generalizable to the groups or populations from which the respondents came. There was a continuum of interest in pharmacist prescribing across the three constituencies. Consumers were predominantly resistant to the notion; however, one third were more positive about the idea. Community pharmacists were more open, particularly when prescribing was restricted to a limited set of conditions or medications. Reimbursement decision-makers were most receptive to the notion. Key barriers to pharmacist prescribing included low awareness of current pharmacist prescribing authority among consumers, concerns about the adequacy of pharmacist training, potential conflicts of interest when the prescriber was also a dispenser, and potential liability issues. Consumer respondents were generally resistant to the notion of pharmacist prescribing, with most viewing pharmacists as dispensers and not prescribers. Community pharmacists were more open to the idea, while reimbursement decision-makers were the most receptive to the notion of pharmacist prescribing. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Assessing Protective Factors for Violence Risk in U.K. General Mental Health Services Using the Structured Assessment of Protective Factors.

PubMed

Haines, Alina; Brown, Andrew; Javaid, Syed Fahad; Khan, Fayyaz; Noblett, Steve; Omodunbi, Oladipupo; Sadiq, Khurram; Zaman, Wahid; Whittington, Richard

2017-12-01

Violence risk assessment and management are key tasks in mental health services and should be guided by validated instruments covering both risk and protective factors. This article is part of an international effort to validate the Structured Assessment of Protective Factors (SAPROF) for violence. The SAPROF, Historical, Clinical, Risk Management-20 (HCR-20) and the Psychopathy Checklist-Screening Version (PCL-SV) were administered in a sample of 261 patients in U.K. forensic, general inpatient, and community mental health settings. There was significant variation between these groups on SAPROF scores with fewer protective factors in the forensic group. The prospective validity of the SAPROF for nonviolence in the general inpatient and community samples was moderate (area under the curve [AUC] = .60). Adoption of the SAPROF or similar instruments as a supplement to risk-focused assessments has the potential to improve awareness of protective factors and enhance therapeutic engagement in a range of mental health services.

Moving health promotion communities online: a review of the literature.

PubMed

Sunderland, Naomi; Beekhuyzen, Jenine; Kendall, Elizabeth; Wolski, Malcom

There is a need to enhance the effectiveness and reach of complex health promotion initiatives by providing opportunities for diverse health promotion practitioners and others to interact in online settings. This paper reviews the existing literature on how to take health promotion communities and networks into online settings. A scoping review of relevant bodies of literature and empirical evidence was undertaken to provide an interpretive synthesis of existing knowledge on the topic. Sixteen studies were identified between 1986 and 2007. Relatively little research has been conducted on the process of taking existing offline communities and networks into online settings. However, more research has focused on offline (i.e. not mediated via computer networks); 'virtual' (purely online with no offline interpersonal contact); and 'multiplex' communities (i.e. those that interact across both online and offline settings). Results are summarised under three themes: characteristics of communities in online and offline settings; issues in moving offline communities online, and designing online communities to match community needs. Existing health promotion initiatives can benefit from online platforms that promote community building and knowledge sharing. Online e-health promotion settings and communities can successfully integrate with existing offline settings and communities to form 'multiplex' communities (i.e. communities that operate fluently across both online and offline settings).

Women's autonomy and child survival: a comparison of Muslims and non-Muslims in four Asian countries.

PubMed

Ghuman, Sharon J

2003-08-01

In this article, I evaluate the hypothesis that higher infant and child mortality among Muslim populations is related to the lower autonomy of Muslim women using data from 15 pairs of Muslim and non-Muslim communities in India, Malaysia, the Philippines, and Thailand. Women's autonomy in various spheres is not consistently lower in Muslim than in non-Muslim settings. Both across and within communities, the association between women's autonomy and mortality is weak, and measures of autonomy or socioeconomic status are generally of limited import for understanding the Muslim disadvantage in children's survival.

Parametric scaling from species to growth-form diversity: an interesting analogy with multifractal functions.

PubMed

Ricotta, Carlo; Pacini, Alessandra; Avena, Giancarlo

2002-01-01

We propose a measure of divergence from species to life-form diversity aimed at summarizing the ecological similarity among different plant communities without losing information on traditional taxonomic diversity. First, species and life-form relative abundances within a given plant community are determined. Next, using Rényi's generalized entropy, the diversity profiles of the analyzed community are computed both from species and life-form relative abundances. Finally, the speed of decrease from species to life-form diversity is obtained by combining the outcome of both profiles. Interestingly, the proposed measure shows some formal analogies with multifractal functions developed in statistical physics for the analysis of spatial patterns. As an application for demonstration, a small data set from a plant community sampled in the archaeological site of Paestum (southern Italy) is used.

A hierarchical framework for investigating epiphyte assemblages: networks, meta-communities, and scale.

PubMed

Burns, K C; Zotz, G

2010-02-01

Epiphytes are an important component of many forested ecosystems, yet our understanding of epiphyte communities lags far behind that of terrestrial-based plant communities. This discrepancy is exacerbated by the lack of a theoretical context to assess patterns in epiphyte community structure. We attempt to fill this gap by developing an analytical framework to investigate epiphyte assemblages, which we then apply to a data set on epiphyte distributions in a Panamanian rain forest. On a coarse scale, interactions between epiphyte species and host tree species can be viewed as bipartite networks, similar to pollination and seed dispersal networks. On a finer scale, epiphyte communities on individual host trees can be viewed as meta-communities, or suites of local epiphyte communities connected by dispersal. Similar analytical tools are typically employed to investigate species interaction networks and meta-communities, thus providing a unified analytical framework to investigate coarse-scale (network) and fine-scale (meta-community) patterns in epiphyte distributions. Coarse-scale analysis of the Panamanian data set showed that most epiphyte species interacted with fewer host species than expected by chance. Fine-scale analyses showed that epiphyte species richness on individual trees was lower than null model expectations. Therefore, epiphyte distributions were clumped at both scales, perhaps as a result of dispersal limitations. Scale-dependent patterns in epiphyte species composition were observed. Epiphyte-host networks showed evidence of negative co-occurrence patterns, which could arise from adaptations among epiphyte species to avoid competition for host species, while most epiphyte meta-communities were distributed at random. Application of our "meta-network" analytical framework in other locales may help to identify general patterns in the structure of epiphyte assemblages and their variation in space and time.

Social Media and Myeloproliferative Neoplasms (MPN): Analysis of Advanced Metrics From the First Year of a New Twitter Community: #MPNSM.

PubMed

Pemmaraju, Naveen; Utengen, Audun; Gupta, Vikas; Kiladjian, Jean-Jacques; Mesa, Ruben; Thompson, Michael A

2016-12-01

The social media platform Twitter has provided the hematology/oncology community with unprecedented, novel methods of interpersonal communication and increased ability for the dissemination of important updates in a rapidly moving field. The advent, and subsequent success, of disease-specific Twitter communities have further enabled interested healthcare stakeholders to become quickly organized around a unique set of rare medical conditions, such as hematologic malignancies, that, historically, generally lack large amounts of reliable online information. One example is the Twitter community #MPNSM (myeloproliferative neoplasms on social media), which was started approximately one and half years ago and has served as a recognized venue for discussion among many members of the MPN community, including patients, researchers, providers, and advocacy organizations. This article will focus on understanding the impact of the founding of this community via the analysis of advanced Twitter metrics of user experience, from the first year of use for this novel healthcare hashtag.

Impact of knowledge of leprosy on the attitude towards leprosy patients: a community study.

PubMed

Raju, M S; Kopparty, S N

1995-01-01

NLEP, through its survey-education-treatment (SET) pattern, attempts to educate the community members about the scientific facts of leprosy with the view to improve their knowledge leading to a more positive attitude towards the leprosy afflicted. This paper explores the impact of knowledge on the attitudes of 1199 community members drawn from two States, Andhra Pradesh and Orissa, towards leprosy. The results show that, overall, a high knowledge level did not necessarily generate positive attitudes. There was a general negative attitude despite 35% to 50% of the respondents having high knowledge level. There were, however, situations in which a high level of knowledge helps to have positive attitudes. These situations differ in the two states studied.

How plants connect pollination and herbivory networks and their contribution to community stability.

PubMed

Sauve, Alix M C; Thébault, Elisa; Pocock, Michael J O; Fontaine, Colin

2016-04-01

Pollination and herbivory networks have mainly been studied separately, highlighting their distinct structural characteristics and the related processes and dynamics. However, most plants interact with both pollinators and herbivores, and there is evidence that both types of interaction affect each other. Here we investigated the way plants connect these mutualistic and antagonistic networks together, and the consequences for community stability. Using an empirical data set, we show that the way plants connect pollination and herbivory networks is not random and promotes community stability. Analyses of the structure of binary and quantitative networks show different results: the plants' generalism with regard to pollinators is positively correlated to their generalism with regard to herbivores when considering binary interactions, but not when considering quantitative interactions. We also show that plants that share the same pollinators do not share the same herbivores. However, the way plants connect pollination and herbivory networks promotes stability for both binary and quantitative networks. Our results highlight the relevance of considering the diversity of interaction types in ecological communities, and stress the need to better quantify the costs and benefits of interactions, as well as to develop new metrics characterizing the way different interaction types are combined within ecological networks.

Sense of community responsibility in community collaboratives: advancing a theory of community as resource and responsibility.

PubMed

Nowell, Branda; Boyd, Neil M

2014-12-01

This paper contributes to the growing body of scholarship aimed at advancing our understanding of the experience of community by empirically investigating sense of community responsibility (SOC-R) in relation to traditional measures of sense of community (SOC) and indices of satisfaction, engagement, and leadership in interorganizational collaborative settings. Findings support the proposition that, although both are related to the experience of community, SOC and SOC-R emphasize different aspects of that experience and operate under different theoretical mechanisms of influence. SOC emphasizes community as a resource which was found to be a more salient aspect in differentiating those who will be more or less satisfied with their experience. In addition, SOC was found to predict general participation in a community collaborative. SOC-R emphasizes the experience of community as a responsibility which appears to be a stronger predictor in explaining higher order engagement requiring greater investment of time and resources. Even more importantly, this study indicates that SOC-R is uniquely equipped to help us advance models of community leadership. As such, it represents an important contribution to expanding our understanding of the factors that drive members' willingness to give of themselves toward collective aims.

Prevalence and clinical implications of improper filter settings in routine electrocardiography.

PubMed

Kligfield, Paul; Okin, Peter M

2007-03-01

High- and low-filter bandwidth governs the fidelity of electrocardiographic waveforms, including the durations used in established criteria for infarction, the amplitudes used for the diagnosis of ventricular hypertrophy, and the accuracy of the magnitudes of ST-segment elevation and depression. Electrocardiographs allow users to reset high- and low-filter settings for special electrocardiographic applications, but these may be used inappropriately. To examine the prevalence of standard and nonstandard electrocardiographic filtering at 1 general medical community, 256 consecutive outpatient electrocardiograms (ECGs) submitted in advance of ambulatory or same-day admission surgery during a 3-week period were examined. ECGs were considered to meet standards for low-frequency cutoff when equal to 0.05 Hz and to meet standards for high-frequency cutoff when equal to 100 Hz, according to American Heart Association recommendations established in 1975. Only 25% of ECGs (65 of 256) conformed to recommended standards; 75% of ECGs (191 of 254) did not. The most prevalent deviation from standard was reduced high-frequency cutoff, which was present in 96% of tracings with nonstandard bandwidth (most commonly 40 Hz). Increased low-frequency cutoff was present in 62% of ECGs in which it was documented. In conclusion, improper electrocardiographic filtering, with potentially adverse clinical consequences, is highly prevalent at 1 large general medical community and is likely a generalized problem. This problem should be resolvable by targeted educational efforts to reinforce technical standards in electrocardiography.

APPROACHES TO JUVENILE DELINQUENCY PREVENTION AND TREATMENT IN RURAL SETTINGS. RURAL AND SMALL-TOWN DELINQUENCY--NEW UNDERSTANDING AND APPROACHES.

ERIC Educational Resources Information Center

SCHAFER, WALTER E.

ALTHOUGH THERE IS A LOWER DELINQUENCY RATE IN RURAL AREAS, THE PROBLEM OF DELINQUENCY IS OF MAJOR CONCERN. THE NATURE OF DELINQUENT ACTS IS USUALLY IN THE FORM OF MINOR BURGLARY, TRESPASSING, AND GENERAL MISCONDUCT, WHILE CHARACTERISTICS OF THE DELINQUENTS INCLUDE LACK OF ACADEMIC ACHIEVEMENT, NEGATIVE ATTITUDES TOWARD SELF AND COMMUNITY, CHOICE…

Having a Diagnosis of Diabetes Is Not Associated with General Diabetes Knowledge in Rural Hispanics

ERIC Educational Resources Information Center

Ceballos, Rachel M.; Coronado, Gloria D.; Thompson, Beti

2010-01-01

Purpose: The prevalence of diabetes among Hispanics in Washington State is 30% greater than it is for non-Hispanic whites. Hispanics also have higher rates of diabetes-related complications and mortality due to the disease. Although interventions have been developed for the Hispanic community, studies in rural settings are limited. To address this…

A comparison of surgical assisting in a prepaid group practice and a community hospital.

PubMed

Lewit, E M; Bentkover, J D; Bentkover, S H; Watkins, R N; Hughes, E F

1980-09-01

Previous studies of the work loads and time utilization of general surgeons in two different practice settings suggested that paraprofessional surgical assistants (SAs) could reduce surgeon assisting time and perhaps increase productivity. In order to further assess the potential advantage of using SAs as surgical assistants, the present study examines assisting patterns in a prepaid group practice where SAs are used and in a community hospital where only physicians are available to assist. In the prepaid group practice, 87 per cent of general surgical procedures were performed with an assistant; in the c ommunity hospital, 67 per cent of general surgical procedures were performed with an assistant. General practitioners also were found to assist in the community hospital; family practice residents, medical students and "others" also assisted in prepaid group. In both settings, the propensity to use an assistant was positively correlated with operative complexity. On operations of greatest complexity, surgeons were most likely to act as first assistants. The use of SAs was not usually associated with operative sessions longer than when surgeons assisted, except on operations of high complexity. In the prepaid group, SAs also frequently assisted on orthopedic surgery, neurosurgery and obstetrics-gynecology, only occasionally on otolaryngology and plastic surgery, and never on ophthalmology. It appears that in organizations such as a prepaid group practice, where mechanisms for sharing resources exist and incentives are provided to minimize the total cost of surgery, the utilization of SAs might be associated with cost savings. At present, organizational and financial barriers exist to the introduction of paraprofessionals as surgical assistants. It is difficult to advocate the modification of these barriers to facilitate the training and large-scale introduction of this new group of paraprofessionals in the current surgical market where there may already be an excess supply of surgeons.

The Bias Associated with Amplicon Sequencing Does Not Affect the Quantitative Assessment of Bacterial Community Dynamics

PubMed Central

Figuerola, Eva L. M.; Erijman, Leonardo

2014-01-01

The performance of two sets of primers targeting variable regions of the 16S rRNA gene V1–V3 and V4 was compared in their ability to describe changes of bacterial diversity and temporal turnover in full-scale activated sludge. Duplicate sets of high-throughput amplicon sequencing data of the two 16S rRNA regions shared a collection of core taxa that were observed across a series of twelve monthly samples, although the relative abundance of each taxon was substantially different between regions. A case in point was the changes in the relative abundance of filamentous bacteria Thiothrix, which caused a large effect on diversity indices, but only in the V1–V3 data set. Yet the relative abundance of Thiothrix in the amplicon sequencing data from both regions correlated with the estimation of its abundance determined using fluorescence in situ hybridization. In nonmetric multidimensional analysis samples were distributed along the first ordination axis according to the sequenced region rather than according to sample identities. The dynamics of microbial communities indicated that V1–V3 and the V4 regions of the 16S rRNA gene yielded comparable patterns of: 1) the changes occurring within the communities along fixed time intervals, 2) the slow turnover of activated sludge communities and 3) the rate of species replacement calculated from the taxa–time relationships. The temperature was the only operational variable that showed significant correlation with the composition of bacterial communities over time for the sets of data obtained with both pairs of primers. In conclusion, we show that despite the bias introduced by amplicon sequencing, the variable regions V1–V3 and V4 can be confidently used for the quantitative assessment of bacterial community dynamics, and provide a proper qualitative account of general taxa in the community, especially when the data are obtained over a convenient time window rather than at a single time point. PMID:24923665

A study of human resource competencies required to implement community rehabilitation in less resourced settings.

PubMed

Gilmore, Brynne; MacLachlan, Malcolm; McVeigh, Joanne; McClean, Chiedza; Carr, Stuart; Duttine, Antony; Mannan, Hasheem; McAuliffe, Eilish; Mji, Gubela; Eide, Arne H; Hem, Karl-Gerhard; Gupta, Neeru

2017-09-22

It is estimated that over one billion persons worldwide have some form of disability. However, there is lack of knowledge and prioritisation of how to serve the needs and provide opportunities for people with disabilities. The community-based rehabilitation (CBR) guidelines, with sufficient and sustained support, can assist in providing access to rehabilitation services, especially in less resourced settings with low resources for rehabilitation. In line with strengthening the implementation of the health-related CBR guidelines, this study aimed to determine what workforce characteristics at the community level enable quality rehabilitation services, with a focus primarily on less resourced settings. This was a two-phase review study using (1) a relevant literature review informed by realist synthesis methodology and (2) Delphi survey of the opinions of relevant stakeholders regarding the findings of the review. It focused on individuals (health professionals, lay health workers, community rehabilitation workers) providing services for persons with disabilities in less resourced settings. Thirty-three articles were included in this review. Three Delphi iterations with 19 participants were completed. Taken together, these produced 33 recommendations for developing health-related rehabilitation services. Several general principles for configuring the community rehabilitation workforce emerged: community-based initiatives can allow services to reach more vulnerable populations; the need for supportive and structured supervision at the facility level; core skills likely include case management, social protection, monitoring and record keeping, counselling skills and mechanisms for referral; community ownership; training in CBR matrix and advocacy; a tiered/teamwork system of service delivery; and training should take a rights-based approach, include practical components, and involve persons with disabilities in the delivery and planning. This research can contribute to implementing the WHO guidelines on the interaction between the health sector and CBR, particularly in the context of the Framework for Action for Strengthening Health Systems, in which human resources is one of six components. Realist syntheses can provide policy makers with detailed and practical information regarding complex health interventions, which may be valuable when planning and implementing programmes.

[Community health in primary health care teams: a management objective].

PubMed

Nebot Adell, Carme; Pasarin Rua, Maribel; Canela Soler, Jaume; Sala Alvarez, Clara; Escosa Farga, Alex

2016-12-01

To describe the process of development of community health in a territory where the Primary Health Care board decided to include it in its roadmap as a strategic line. Evaluative research using qualitative techniques, including SWOT analysis on community health. Two-steps study. Primary care teams (PCT) of the Catalan Health Institute in Barcelona city. The 24 PCT belonging to the Muntanya-Dreta Primary Care Service in Barcelona city, with 904 professionals serving 557,430 inhabitants. Application of qualitative methodology using SWOT analysis in two steps (two-step study). Step 1: Setting up a core group consisting of local PCT professionals; collecting the community projects across the territory; SWOT analysis. Step 2: From the needs identified in the previous phase, a plan was developed, including a set of training activities in community health: basic, advanced, and a workshop to exchange experiences from the PCTs. A total of 80 team professionals received specific training in the 4 workshops held, one of them an advanced level. Two workshops were held to exchange experiences with 165 representatives from the local teams, and 22 PCTs presenting their practices. In 2013, 6 out of 24 PCTs have had a community diagnosis performed. Community health has achieved a good level of development in some areas, but this is not the general situation in the health care system. Its progression depends on the management support they have, the local community dynamics, and the scope of the Primary Health Care. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

'…a one stop shop in their own community': Medical abortion and the role of general practice.

PubMed

Newton, Danielle; Bayly, Chris; McNamee, Kathleen; Bismark, Marie; Hardiman, Annarella; Webster, Amy; Keogh, Louise

2016-12-01

The introduction to Australia of modern medical abortion methods, which require less specialist expertise and equipment than the more traditional surgical methods, have brought an as yet unrealised potential to improve access to abortion services. To investigate the potential for expanding the role of general practice in the provision of medical abortion in Victoria. In 2015, in-depth interviews were conducted with 19 experts in abortion service provision in Victoria. A semi-structured interview schedule was used to guide the interviews. Interviews were transcribed verbatim and transcripts analysed thematically. Participants were largely very supportive of the provision of early medical abortion in general practice as a way of increasing abortion access for women, particularly in rural and regional communities. Access to abortion was seen as an essential component of women's comprehensive health care and therefore general practitioners (GPs) were perceived as ideally placed to provide this service. However, this would require development and implementation of new service models, careful consideration of GP and nurse roles, strengthening of partnerships with other health professionals and services in the community, and enhanced training, support and mentoring for clinicians. The application of these findings by relevant health services and agencies has the potential to increase provision of medical abortion services in general practice settings, better meeting the health-care needs of women seeking this service. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Measurement of patient satisfaction with community pharmacy services: a review.

PubMed

Naik Panvelkar, Pradnya; Saini, Bandana; Armour, Carol

2009-10-01

The aim of this review is to conduct an in-depth analysis of the available literature in order to identify and evaluate studies measuring patient satisfaction with pharmacy services delivered by pharmacists in a community setting. An extensive literature search was conducted in five databases (Medline, Scopus, Embase, Psychinfo, International Pharmaceutical Abstracts) using the search terms "patient/client/consumer satisfaction" AND "community pharmacy/pharmacies" AND "pharmacy service/pharmaceutical services/pharmacy program/intervention/intervention studies". Only those articles where the main focus was measuring patient satisfaction with services delivered in community pharmacies were included in the review. Patient satisfaction was explored with three different levels of pharmacy services -- general services, intervention services and cognitive services. Twenty-four articles measuring patient satisfaction with community pharmacy services were retrieved. Of these, eleven measured patient satisfaction with general services, six measured satisfaction with intervention services and seven measured satisfaction with cognitive services. The majority of studies reviewed had adopted and measured satisfaction as a multidimensional construct. None of the studies reviewed tested any theoretical models of satisfaction. Further a lack of consistent instruments measuring patient satisfaction was observed, with most of the reviewed studies using self developed, non-validated or ad hoc instruments with items from various previously published papers. The review also observed high levels of patient satisfaction with pharmacy services be they general, intervention or cognitive services. This review found that patient satisfaction has been measured within the community pharmacy context to a certain degree. Further research is needed to develop and test instruments based on theoretical frameworks, to test satisfaction pre and post hoc and in well designed randomized controlled trials and to measure changes in satisfaction over time. Novel approaches involving an understanding of expectations and preferences of patients and matching these to the services provided also need to be explored.

Empowering community settings: agents of individual development, community betterment, and positive social change.

PubMed

Maton, Kenneth I

2008-03-01

The pathways and processes through which empowering community settings influence their members, the surrounding community and the larger society are examined. To generate the proposed pathways and processes, a broad range of studies of community settings were reviewed, in the domains of adult well-being, positive youth development, locality development, and social change. A set of organizational characteristics and associated processes leading to member empowerment across domains were identified, as well as three pathways through which empowering settings in each domain contribute to community betterment and positive social change. The paper concludes with an examination of the ways that community psychology and allied disciplines can help increase the number and range of empowering settings, and enhance the community and societal impact of existing ones.

Contrasting the effects of environment, dispersal and biotic interactions to explain the distribution of invasive plants in alpine communities

PubMed Central

GALLIEN, Laure; MAZEL, Florent; LAVERGNE, Sébastien; RENAUD, Julien; DOUZET, Rolland; THUILLER, Wilfried

2015-01-01

Despite considerable efforts devoted to investigate the community assembly processes driving plant invasions, few general conclusions have been drawn so far. Three main processes, generally acting as successive filters, are thought to be of prime importance. The invader has to disperse (1st filter) into a suitable environment (2nd filter) and succeed in establishing in recipient communities through competitive interactions (3rd filter) using two strategies: competition avoidance by the use of different resources (resource opportunity), or competitive exclusion of native species. Surprisingly, despite the general consensus on the importance of investigating these three processes and their interplay, they are usually studied independently. Here we aim to analyse these three filters together, by including them all: abiotic environment, dispersal and biotic interactions, into models of invasive species distributions. We first propose a suite of indices (based on species functional dissimilarities) supposed to reflect the two competitive strategies (resource opportunity and competition exclusion). Then, we use a set of generalised linear models to explain the distribution of seven herbaceous invaders in natural communities (using a large vegetation database for the French Alps containing 5,000 community-plots). Finally, we measure the relative importance of competitive interaction indices, identify the type of coexistence mechanism involved and how this varies along environmental gradients. Adding competition indices significantly improved model’s performance, but neither resource opportunity nor competitive exclusion were common strategies among the seven species. Overall, we show that combining environmental, dispersal and biotic information to model invasions has excellent potential for improving our understanding of invader success. PMID:26290653

Implementing an anti-smoking program in rural-remote communities: challenges and strategies.

PubMed

Tall, Julie A; Brew, Bronwyn K; Saurman, Emily; Jones, Therese C

2015-01-01

Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

Molecular typing of antibiotic-resistant Staphylococcus aureus in Nigeria.

PubMed

O'Malley, S M; Emele, F E; Nwaokorie, F O; Idika, N; Umeizudike, A K; Emeka-Nwabunnia, I; Hanson, B M; Nair, R; Wardyn, S E; Smith, T C

2015-01-01

Antibiotic-resistant Staphylococcus aureus including methicillin-resistant strains (MRSA) are a major concern in densely populated urban areas. Initial studies of S. aureus in Nigeria indicated existence of antibiotic-resistant S. aureus strains in clinical and community settings. 73 biological samples (40 throat, 23 nasal, 10 wound) were collected from patients and healthcare workers in three populations in Nigeria: Lagos University Teaching Hospital, Nigerian Institute of Medical Research, and Owerri General Hospital. S. aureus was isolated from 38 of 73 samples (52%). Of the 38 S. aureus samples, 9 (24%) carried the Panton-Valentine leukocidin gene (PVL) while 16 (42%) possessed methicillin resistance genes (mecA). Antibiotic susceptibility profiles indicated resistance to several broad-spectrum antibiotics. Antibiotic-resistant S. aureus isolates were recovered from clinical and community settings in Nigeria. Insight about S. aureus in Nigeria may be used to improve antibiotic prescription methods and minimize the spread of antibiotic-resistant organisms in highly populated urban communities similar to Lagos, Nigeria. Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Family physicians who have focused practices in oncology: results of a national survey.

PubMed

Sisler, Jeffrey J; DeCarolis, Mary; Robinson, Deborah; Sivananthan, Gokulan

2013-06-01

To characterize the demographic characteristics, practice profile, and current work life of general practitioners in oncology (GPOs) for the first time. National Web survey performed in March 2011. Canada. Members of the national GPO organization. Respondents were asked to forward the survey to non-member colleagues. Profile of work as GPOs and in other medical roles, training received, demographic characteristics, and professional satisfaction. The response rate was 73.3% for members of the Canadian Association of General Practitioners in Oncology; overall, 120 surveys were completed. Respondents worked in similar proportions in small and larger communities. About 60% of them had participated in formal training programs. Most respondents worked part-time as GPOs and also worked in other medical roles, particularly palliative care, primary care practice, teaching, and hospital work. More GPOs from cities with populations of greater than 100 000 worked solely as GPOs than those from smaller communities (P = .0057). General practitioners in oncology played a variety of roles in the cancer care system, particularly in systemic therapy, palliative care, inpatient care, and teaching. As a group, more than half of respondents were involved in the care of each of the 11 common cancer types. Overall, 87.8% of respondents worked in outpatient care, 59.1% provided inpatient care, and 33.0% provided on-call services; 92.8% were satisfied with their work as GPOs. General practitioners in oncology are involved in all cancer care settings and usually combine this work with other roles, particularly with palliative care in rural Canada. Training is inconsistent but initiatives are under way to address this. Job satisfaction is better than that of Canadian FPs in general. As generalists, FPs bring a valuable skill set to their work as GPOs in the cancer care system.

Central On-Line Data Directory

NASA Technical Reports Server (NTRS)

Thieman, J.

1986-01-01

The National Space Science Data Center (NSSDC) Central On-Line Data Directory (CODD), which allows the general scientist remote access to information about data sets available not only at NSSDC, but throughout the scientific community, is discussed. A user may search for data set information within CODD by specifying spacecraft name, experiment name, investigator name, and/or keywords. CODD will include information on atmospheric science data sets contained not only within the PCDS, but also within other data sets that are deemed important. Keywords to be used in locating these data sets are currently being formulated. The main type of keyword to be used for categorization of data sets will be discipline related. The primary discipline keyword for PCDS-type data sets would be ATMOSPHERIC SCIENCE. A good set of subdiscipline keywords is needed under this discipline to subdivide the data sets. A sheet containing a strawman set of subdiscipline keywords was distributed, and a request was made for the knowledgeable scientists to modify or replace the proposed keywords.

Establishing a professional profile of community health workers: results from a national study of roles, activities and training.

PubMed

Ingram, Maia; Reinschmidt, Kerstin M; Schachter, Ken A; Davidson, Chris L; Sabo, Samantha J; De Zapien, Jill Guernsey; Carvajal, Scott C

2012-04-01

Community Health Workers (CHWs) have gained national recognition for their role in addressing health disparities and are increasingly integrated into the health care delivery system. There is a lack of consensus, however, regarding empirical evidence on the impact of CHW interventions on health outcomes. In this paper, we present results from the 2010 National Community Health Worker Advocacy Survey (NCHWAS) in an effort to strengthen a generalized understanding of the CHW profession that can be integrated into ongoing efforts to improve the health care delivery system. Results indicate that regardless of geographical location, work setting, and demographic characteristics, CHWs generally share similar professional characteristics, training preparation, and job activities. CHWs are likely to be female, representative of the community they serve, and to work in community health centers, clinics, community-based organizations, and health departments. The most common type of training is on-the-job and conference training. Most CHWs work with clients, groups, other CHWs and less frequently community leaders to address health issues, the most common of which are chronic disease, prevention and health care access. Descriptions of CHW activities documented in the survey demonstrate that CHWs apply core competencies in a synergistic manner in an effort to assure that their clients get the services they need. NCHWAS findings suggest that over the past 50 years, the CHW field has become standardized in response to the unmet needs of their communities. In research and practice, the field would benefit from being considered a health profession rather than an intervention.

Reducing under-five mortality through Hôpital Albert Schweitzer's integrated system in Haiti.

PubMed

Perry, Henry; Cayemittes, Michel; Philippe, Francois; Dowell, Duane; Dortonne, Jean Richard; Menager, Henri; Bottex, Erve; Berggren, Warren; Berggren, Gretchen

2006-05-01

The degree to which local health systems contribute to reductions in under-five mortality in severely impoverished settings has not been well documented. The current study compares the under-five mortality in the Hôpital Albert Schweitzer (HAS) Primary Health Care Service Area with that for Haiti in general. HAS provides an integrated system of community-based primary health care services, hospital care and community development. A sample of 10% of the women of reproductive age in the HAS service area was interviewed, and 2390 live births and 149 child deaths were documented for the period 1995-99. Under-five mortality rates were computed and compared with rates for Haiti. In addition, available data regarding inputs, processes and outputs for the HAS service area and for Haiti were assembled and compared. Under-five mortality was 58% less in the HAS service area, and mortality for children 12-59 months of age was 76% less. These results were achieved with an input of fewer physicians and hospital beds per capita than is available for Haiti nationwide, but with twice as many graduate nurses and auxiliary nurses per capita than are available nationwide, and with three cadres of health workers that do not exist nationwide: Physician Extenders, Health Agents and Community Health Volunteers. The population coverage of targeted child survival services was generally 1.5-2 times higher in the HAS service area than in rural Haiti. These findings support the conclusion that a well-developed system of primary health care, with outreach services to the household level, integrated with hospital referral care and community development programmes, can make a strong contribution to reducing infant and child mortality in severely impoverished settings.

Nonpareil 3: Fast Estimation of Metagenomic Coverage and Sequence Diversity.

PubMed

Rodriguez-R, Luis M; Gunturu, Santosh; Tiedje, James M; Cole, James R; Konstantinidis, Konstantinos T

2018-01-01

Estimations of microbial community diversity based on metagenomic data sets are affected, often to an unknown degree, by biases derived from insufficient coverage and reference database-dependent estimations of diversity. For instance, the completeness of reference databases cannot be generally estimated since it depends on the extant diversity sampled to date, which, with the exception of a few habitats such as the human gut, remains severely undersampled. Further, estimation of the degree of coverage of a microbial community by a metagenomic data set is prohibitively time-consuming for large data sets, and coverage values may not be directly comparable between data sets obtained with different sequencing technologies. Here, we extend Nonpareil, a database-independent tool for the estimation of coverage in metagenomic data sets, to a high-performance computing implementation that scales up to hundreds of cores and includes, in addition, a k -mer-based estimation as sensitive as the original alignment-based version but about three hundred times as fast. Further, we propose a metric of sequence diversity ( N d ) derived directly from Nonpareil curves that correlates well with alpha diversity assessed by traditional metrics. We use this metric in different experiments demonstrating the correlation with the Shannon index estimated on 16S rRNA gene profiles and show that N d additionally reveals seasonal patterns in marine samples that are not captured by the Shannon index and more precise rankings of the magnitude of diversity of microbial communities in different habitats. Therefore, the new version of Nonpareil, called Nonpareil 3, advances the toolbox for metagenomic analyses of microbiomes. IMPORTANCE Estimation of the coverage provided by a metagenomic data set, i.e., what fraction of the microbial community was sampled by DNA sequencing, represents an essential first step of every culture-independent genomic study that aims to robustly assess the sequence diversity present in a sample. However, estimation of coverage remains elusive because of several technical limitations associated with high computational requirements and limiting statistical approaches to quantify diversity. Here we described Nonpareil 3, a new bioinformatics algorithm that circumvents several of these limitations and thus can facilitate culture-independent studies in clinical or environmental settings, independent of the sequencing platform employed. In addition, we present a new metric of sequence diversity based on rarefied coverage and demonstrate its use in communities from diverse ecosystems.

Interconnected microbiomes and resistomes in low-income human habitats

PubMed Central

Pehrsson, Erica C.; Tsukayama, Pablo; Patel, Sanket; Mejía-Bautista, Melissa; Sosa-Soto, Giordano; Navarrete, Karla M.; Calderon, Maritza; Cabrera, Lilia; Hoyos-Arango, William; Bertoli, M. Teresita; Berg, Douglas E.; Gilman, Robert H.; Dantas, Gautam

2016-01-01

Summary Antibiotic-resistant infections annually claim hundreds of thousands of lives worldwide. This problem is exacerbated by resistance gene exchange between pathogens and benign microbes from diverse habitats. Mapping resistance gene dissemination between humans and their environment is a public health priority. We characterized the bacterial community structure and resistance exchange networks of hundreds of interconnected human fecal and environmental samples from two low-income Latin American communities. We found that resistomes across habitats are generally structured by bacterial phylogeny along ecological gradients, but identified key resistance genes that cross habitat boundaries and determined their association with mobile genetic elements. We also assessed the effectiveness of widely-used excreta management strategies in reducing fecal bacteria and resistance genes in these settings representative of low- and middle-income countries. Our results lay the foundation for quantitative risk assessment and surveillance of resistance dissemination across interconnected habitats in settings representing over two-thirds of the world’s population. PMID:27172044

Merkel cell carcinoma in the community setting: a case report.

PubMed

Callaghan, Cameron M; Amornmarn, Rumpa

2018-04-12

Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin initially believed to arise from the Merkel cells. In the community setting a general radiation oncologist may only encounter this pathology in a handful of cases over the course of their career. Due to the low incidence of this malignancy, few prospective randomized controlled trials have ever been conducted and therefore guidelines are based on relatively lower levels of evidence upon which the clinical recommendations are made. We discuss the case of a female in her 90s presenting with a classic MCC primary lesion, as well as satellite lesions proximal to both the primary and the draining regional lymph nodes with no evidence of nodal involvement. Here we discuss the presentation, management, treatment planning, underlying pathology, results and sequelae of treatment. We also review new treatment modalities, and the most current staging systems and guidelines.

Dynamic Infinite Mixed-Membership Stochastic Blockmodel.

PubMed

Fan, Xuhui; Cao, Longbing; Xu, Richard Yi Da

2015-09-01

Directional and pairwise measurements are often used to model interactions in a social network setting. The mixed-membership stochastic blockmodel (MMSB) was a seminal work in this area, and its ability has been extended. However, models such as MMSB face particular challenges in modeling dynamic networks, for example, with the unknown number of communities. Accordingly, this paper proposes a dynamic infinite mixed-membership stochastic blockmodel, a generalized framework that extends the existing work to potentially infinite communities inside a network in dynamic settings (i.e., networks are observed over time). Additional model parameters are introduced to reflect the degree of persistence among one's memberships at consecutive time stamps. Under this framework, two specific models, namely mixture time variant and mixture time invariant models, are proposed to depict two different time correlation structures. Two effective posterior sampling strategies and their results are presented, respectively, using synthetic and real-world data.

Generalised power graph compression reveals dominant relationship patterns in complex networks

PubMed Central

Ahnert, Sebastian E.

2014-01-01

We introduce a framework for the discovery of dominant relationship patterns in complex networks, by compressing the networks into power graphs with overlapping power nodes. When paired with enrichment analysis of node classification terms, the most compressible sets of edges provide a highly informative sketch of the dominant relationship patterns that define the network. In addition, this procedure also gives rise to a novel, link-based definition of overlapping node communities in which nodes are defined by their relationships with sets of other nodes, rather than through connections within the community. We show that this completely general approach can be applied to undirected, directed, and bipartite networks, yielding valuable insights into the large-scale structure of real-world networks, including social networks and food webs. Our approach therefore provides a novel way in which network architecture can be studied, defined and classified. PMID:24663099

Fall Prevention in a Primary Care Setting.

PubMed

Siegrist, Monika; Freiberger, Ellen; Geilhof, Barbara; Salb, Johannes; Hentschke, Christian; Landendoerfer, Peter; Linde, Klause; Halle, Martin; Blank, Wolfgang A

2016-05-27

Falls and fall-related injuries are common in community-dwelling elderly people. Effective multifactorial fall prevention programs in the primary care setting may be a promising approach to reduce the incidence rate of falls. In a cluster randomized trial in 33 general practices 378 people living independently and at high risk of falling (65 to 94 years old; 285 women) were allocated to either a 16 week exercise-based fall prevention program including muscle strengthening and challenging balance training exercises, combined with a 12 week home-based exercise program (222 participants), or to usual care (156 participants). The main outcome was number of falls over a period of 12 months. Secondary outcomes were the number of fall-related injuries, physical function (Timed-Up-and-Go-Test, TUG, Chair-Stand-Test, CST, modified Romberg Test), and fear of falling. In the intervention group (n=222 patients in 17 general practices) 291 falls occurred, compared to 367 falls in the usual care group (n=156 patients in 16 general practices). We observed a lower incidence rate for falls in the intervention group (incidence rate ratio/IRR: 0.54; 95% confidence interval (CI): [0.35; 0.84], p=0.007) and for fall-related injuries (IRR: 0.66; [0.42; 0.94], p=0.033). Additionally, patients in the intervention group showed significant improvements in secondary endpoints (TUG: -2.39 s, [-3.91; -0.87], p=0.014; mRomberg: 1.70 s, [0.35; 3.04], p=0.037; fear of falling: -2.28 points, [-3.87; -0.69], p=0.022) compared to usual care. A complex falls prevention program in a primary care setting was effective in reducing falls and fall-related injuries in community dwelling older adults at risk.

Organizational context, systems change, and adopting treatment delivery systems in the criminal justice system.

PubMed

Taxman, Faye S; Henderson, Craig E; Belenko, Steven

2009-08-01

The correctional system does not include service provision as a primary goal, even though individuals in prison, jail, and on probation/parole have large unmet substance abuse treatment needs. In response to mandates in the U.S. Constitution for basic health care, services are provided for incarcerated offenders, but generally do not include substance abuse treatment. The system does little to extend any type of health care service to individuals in community settings. This leaves the majority of offenders (6 million under community supervision in the U.S.) basically unattended, even with substance abuse disorders that are four times greater than the general public. The challenge of adapting the correctional system to be part of an integrated service provision system - working in conjunction with the public and private community-based service delivery sector - has intrigued researchers and policy makers over the last two decades. A series of articles using data from the National Criminal Justice Treatment Practices survey have examined factors that influence the adoption of a myriad of substance abuse treatment services for offender populations in various settings. These articles explore the factors that affect adoption and implementation, and provide guidance on issues relevant to organizational change and a dual mission of correctional agencies to advance public safety and public health. This special issue of Drug and Alcohol Dependence is devoted to understanding organizational constructs and factors to improve health outcomes for offenders.

Reducing violence in poor urban areas of Honduras by building community resilience through community-based interventions.

PubMed

Hansen-Nord, Nete Sloth; Kjaerulf, Finn; Almendarez, Juan; Rodas, Victor Morales; Castro, Julio

2016-11-01

To examine the impact of a 3 year community-based violence prevention intervention on risk of violence and social capital in two poor urban communities in Honduras in 2011-2014. A quasi-experimental design pre and post implementation of the intervention was conducted based on data from two randomly selected samples using the same structured questionnaire in 2011 and in 2014. Community members had a 42 % lower risk of violence in 2014 compared to 2011. There was a positive relation between participation in the intervention and structural social capital, and participants had more than twice the likelihood of engaging in citizenship activities compared to the general population. The intervention contributed to decreasing violence and increasing community resilience in two urban areas in Honduras. Citizenship activities and active community participation in the violence prevention agenda rather than social trust and cohesion characteristics was affected by the intervention. This research introduces important lessons learned to future researchers aiming to retrieve very sensitive data in a similarly violent setting, and provides strong research opportunities within areas, which to this date remain undiscovered.

Best practice principles for community-based obesity prevention: development, content and application.

PubMed

King, L; Gill, T; Allender, S; Swinburn, B

2011-05-01

Best practice in obesity prevention has generally been defined in terms of 'what' needs to be done while neglecting 'how'. A multifaceted definition of best practice, which combines available evidence on what actions to take, with an established process for interpreting this information in a specific community context, provides a more appropriate basis for defining the principles of best practice in community-based obesity prevention. Based on analysis of a range of literature, a preliminary set of principles was drafted and progressively revised through further analyses of published literature and a series of consultations. The framework for best practice principles comprises: community engagement, programme design and planning, evaluation, implementation and sustainability, and governance. Specific principles were formulated within this framework. While many principles were generic, distinctive features of obesity prevention were also covered. The engagement of end-users influenced the design of the formatting of the outputs, which represent three levels of knowledge transfer: detailed evidence summaries, guiding questions for programme planners and a briefer set of questions for simpler communication purposes. The best practice principles provide a valuable mechanism for the translation of existing evidence and experience into the decision-making processes for planning, implementing and evaluating the complex community-based interventions needed for successful obesity prevention. © 2010 The Authors. obesity reviews © 2010 International Association for the Study of Obesity.

Merging Marine Ecosystem Models and Genomics

NASA Astrophysics Data System (ADS)

Coles, V.; Hood, R. R.; Stukel, M. R.; Moran, M. A.; Paul, J. H.; Satinsky, B.; Zielinski, B.; Yager, P. L.

2015-12-01

oceanography. One of the grand challenges of oceanography is to develop model techniques to more effectively incorporate genomic information. As one approach, we developed an ecosystem model whose community is determined by randomly assigning functional genes to build each organism's "DNA". Microbes are assigned a size that sets their baseline environmental responses using allometric response cuves. These responses are modified by the costs and benefits conferred by each gene in an organism's genome. The microbes are embedded in a general circulation model where environmental conditions shape the emergent population. This model is used to explore whether organisms constructed from randomized combinations of metabolic capability alone can self-organize to create realistic oceanic biogeochemical gradients. Realistic community size spectra and chlorophyll-a concentrations emerge in the model. The model is run repeatedly with randomly-generated microbial communities and each time realistic gradients in community size spectra, chlorophyll-a, and forms of nitrogen develop. This supports the hypothesis that the metabolic potential of a community rather than the realized species composition is the primary factor setting vertical and horizontal environmental gradients. Vertical distributions of nitrogen and transcripts for genes involved in nitrification are broadly consistent with observations. Modeled gene and transcript abundance for nitrogen cycling and processing of land-derived organic material match observations along the extreme gradients in the Amazon River plume, and they help to explain the factors controlling observed variability.

Back to Basics--The Influence of DNA Extraction and Primer Choice on Phylogenetic Analysis of Activated Sludge Communities.

PubMed

Albertsen, Mads; Karst, Søren M; Ziegler, Anja S; Kirkegaard, Rasmus H; Nielsen, Per H

2015-01-01

DNA extraction and primer choice have a large effect on the observed community structure in all microbial amplicon sequencing analyses. Although the biases are well known, no comprehensive analysis has been conducted in activated sludge communities. In this study we systematically explored the impact of a number of parameters on the observed microbial community: bead beating intensity, primer choice, extracellular DNA removal, and various PCR settings. In total, 176 samples were subjected to 16S rRNA amplicon sequencing, and selected samples were investigated through metagenomics and metatranscriptomics. Quantitative fluorescence in situ hybridization was used as a DNA extraction-independent method for qualitative comparison. In general, an effect on the observed community was found on all parameters tested, although bead beating and primer choice had the largest effect. The effect of bead beating intensity correlated with cell-wall strength as seen by a large increase in DNA from Gram-positive bacteria (up to 400%). However, significant differences were present at lower phylogenetic levels within the same phylum, suggesting that additional factors are at play. The best primer set based on in silico analysis was found to underestimate a number of important bacterial groups. For 16S rRNA gene analysis in activated sludge we recommend using the FastDNA SPIN Kit for Soil with four times the normal bead beating and V1-3 primers.

Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence.

PubMed

Veale, David; Gledhill, Lucinda J; Christodoulou, Polyxeni; Hodsoll, John

2016-09-01

Our aim was to systematically review the prevalence of body dysmorphic disorder (BDD) in a variety of settings. Weighted prevalence estimate and 95% confidence intervals in each study were calculated. The weighted prevalence of BDD in adults in the community was estimated to be 1.9%; in adolescents 2.2%; in student populations 3.3%; in adult psychiatric inpatients 7.4%; in adolescent psychiatric inpatients 7.4%; in adult psychiatric outpatients 5.8%; in general cosmetic surgery 13.2%; in rhinoplasty surgery 20.1%; in orthognathic surgery 11.2%; in orthodontics/cosmetic dentistry settings 5.2%; in dermatology outpatients 11.3%; in cosmetic dermatology outpatients 9.2%; and in acne dermatology clinics 11.1%. Women outnumbered men in the majority of settings but not in cosmetic or dermatological settings. BDD is common in some psychiatric and cosmetic settings but is poorly identified. Copyright © 2016 Elsevier Ltd. All rights reserved.

The APA/HRSA Faculty Development Scholars Program: introduction to the supplement.

PubMed

Osborn, Lucy M; Roberts, Kenneth B; Greenberg, Larrie; DeWitt, Tom; Devries, Jeffrey M; Wilson, Modena; Simpson, Deborah E

2004-01-01

The purpose of this project was to improve pediatric primary care medical education by providing faculty development for full-time and community-based faculty who teach general pediatrics to medical students and/or residents in ambulatory pediatric community-based settings. Funding for the program came through an interagency agreement with the Health Resources and Services Administration (HRSA) and the Agency for Healthcare Research and Quality (AHRQ). A train-the-trainer model was used to train 112 scholars who could teach skills to general pediatric faculty across the nation. The three scholar groups focused on community-based ambulatory teaching; educational scholarship; and executive leadership. Scholars felt well prepared to deliver faculty development programs in their home institutions and regions. They presented 599 workshops to 7989 participants during the course of the contract. More than 50% of scholars assumed positions of leadership, and most reported increased support for medical education in their local and regional environments. This national pediatric faculty development program pioneered in the development of a new training model and should guide training of new scholars and advanced and continuing training for those who complete a basic program.

Comparison of community and hospital pharmacists' attitudes and behaviors on medication error disclosure to the patient: A pilot study.

PubMed

Kim, ChungYun; Mazan, Jennifer L; Quiñones-Boex, Ana C

To determine pharmacists' attitudes and behaviors on medication errors and their disclosure and to compare community and hospital pharmacists on such views. An online questionnaire was developed from previous studies on physicians' disclosure of errors. Questionnaire items included demographics, environment, personal experiences, and attitudes on medication errors and the disclosure process. An invitation to participate along with the link to the questionnaire was electronically distributed to members of two Illinois pharmacy associations. A follow-up reminder was sent 4 weeks after the original message. Data were collected for 3 months, and statistical analyses were performed with the use of IBM SPSS version 22.0. The overall response rate was 23.3% (n = 422). The average employed respondent was a 51-year-old white woman with a BS Pharmacy degree working in a hospital pharmacy as a clinical staff member. Regardless of practice settings, pharmacist respondents agreed that medication errors were inevitable and that a disclosure process is necessary. Respondents from community and hospital settings were further analyzed to assess any differences. Community pharmacist respondents were more likely to agree that medication errors were inevitable and that pharmacists should address the patient's emotions when disclosing an error. Community pharmacist respondents were also more likely to agree that the health care professional most closely involved with the error should disclose the error to the patient and thought that it was the pharmacists' responsibility to disclose the error. Hospital pharmacist respondents were more likely to agree that it was important to include all details in a disclosure process and more likely to disagree on putting a "positive spin" on the event. Regardless of practice setting, responding pharmacists generally agreed that errors should be disclosed to patients. There were, however, significant differences in their attitudes and behaviors depending on their particular practice setting. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Hints for the aspiring public health nurse. 1923.

PubMed

Abrams, Sarah E

2010-01-01

The original article from which these excerpts were taken, "Some Hints to the Nurse Who Seeks to Become a Successful Partner in the Community Health Program," by Mary Margaret Muckley, was published the 1923 volume of the original Public Health Nursing journal. The paper listed practical pointers to nurses wanting to work in the area of public or community health nursing. The author's advice involved personal attributes, professional engagement, skills, effective organization, and community relations. Much of the original article contained sound advice for aspirants to nursing work in community settings, but some advice may be considered too idealistic even for this optimistic time period. While the particular references to organizations and agencies existing in Helena, Montana have been omitted, the nurse reading the paper in 1923 had a general guide to her key stakeholders. The excerpts from this paper may give contemporary readers an appreciation of the endurance of what Muckley terms the public health nurse's "Valuable Assets."

Planetary Data Workshop, Part 1

NASA Technical Reports Server (NTRS)

1984-01-01

The community of planetary scientists addresses two general problems regarding planetary science data: (1) important data sets are being permanently lost; and (2) utilization is constrainted by difficulties in locating and accessing science data and supporting information necessary for its use. A means to correct the problems, provide science and functional requirements for a systematic and phased approach, and suggest technologies and standards appropriate to the solution were explored.

Evaluation of a national programme to reduce inappropriate use of antibiotics for upper respiratory tract infections: effects on consumer awareness, beliefs, attitudes and behaviour in Australia.

PubMed

Wutzke, Sonia E; Artist, Margaret A; Kehoe, Linda A; Fletcher, Miriam; Mackson, Judith M; Weekes, Lynn M

2007-03-01

The over-use of antibiotics, in particular, inappropriate use to treat upper respiratory tract infections (URTIs), is a global public health concern. In an attempt to reduce inappropriate use of antibiotics for URTIs, and, in particular, to modify patient misconceptions about the effectiveness of antibiotics for URTIs, Australia's National Prescribing Service Ltd (NPS) has undertaken a comprehensive, multistrategic programme for health professionals and the community. Targeted strategies for the community, via the NPS common colds community campaign, commenced in 2000 and have been repeated annually during the winter months. Community strategies were closely integrated, using the same tagline, key messages and visual images, and were delivered in numerous settings including general practice, community pharmacy, child-care centres and community groups. Strategies included written information via newsletters and brochures, mass media activity using billboards, television, radio and magazines and small grants to promote local community education. The evaluation used multiple methods and data sources to measure process, impact and outcomes. Consistent with intervention messages, the integrated nationwide prescriber and consumer programme is associated with modest but consistent positive changes in consumer awareness, beliefs, attitudes and behaviour to the appropriate use of antibiotics for URTIs. These positive changes among the community are corroborated by a national decline in total antibiotic prescriptions dispensed in the community (from 23.08 million prescriptions in 1998-99 to 21.44 million in 2001-02) and, specifically, by a decline among the nine antibiotics commonly used for URTI such that by 2003 nationally 216,000 fewer prescriptions for URTI are written each year by general practitioners.

Accurate detection of hierarchical communities in complex networks based on nonlinear dynamical evolution

NASA Astrophysics Data System (ADS)

Zhuo, Zhao; Cai, Shi-Min; Tang, Ming; Lai, Ying-Cheng

2018-04-01

One of the most challenging problems in network science is to accurately detect communities at distinct hierarchical scales. Most existing methods are based on structural analysis and manipulation, which are NP-hard. We articulate an alternative, dynamical evolution-based approach to the problem. The basic principle is to computationally implement a nonlinear dynamical process on all nodes in the network with a general coupling scheme, creating a networked dynamical system. Under a proper system setting and with an adjustable control parameter, the community structure of the network would "come out" or emerge naturally from the dynamical evolution of the system. As the control parameter is systematically varied, the community hierarchies at different scales can be revealed. As a concrete example of this general principle, we exploit clustered synchronization as a dynamical mechanism through which the hierarchical community structure can be uncovered. In particular, for quite arbitrary choices of the nonlinear nodal dynamics and coupling scheme, decreasing the coupling parameter from the global synchronization regime, in which the dynamical states of all nodes are perfectly synchronized, can lead to a weaker type of synchronization organized as clusters. We demonstrate the existence of optimal choices of the coupling parameter for which the synchronization clusters encode accurate information about the hierarchical community structure of the network. We test and validate our method using a standard class of benchmark modular networks with two distinct hierarchies of communities and a number of empirical networks arising from the real world. Our method is computationally extremely efficient, eliminating completely the NP-hard difficulty associated with previous methods. The basic principle of exploiting dynamical evolution to uncover hidden community organizations at different scales represents a "game-change" type of approach to addressing the problem of community detection in complex networks.

Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013-2014.

PubMed

Seguin, Rebecca A; Morgan, Emily H; Connor, Leah M; Garner, Jennifer A; King, Abby C; Sheats, Jylana L; Winter, Sandra J; Buman, Matthew P

2015-07-02

A community's built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement. Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change. Twenty-four adults (mean age, 69.4 y (standard deviation, 13.2 y), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use. An electronic tablet-based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions.

The application of a biometric identification technique for linking community and hospital data in rural Ghana

PubMed Central

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

Background The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Objective Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. Design A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. Results A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Conclusions Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information. PMID:26993473

The application of a biometric identification technique for linking community and hospital data in rural Ghana.

PubMed

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.

Information needs of parents for acute childhood illness: determining ‘what, how, where and when’ of safety netting using a qualitative exploration with parents and clinicians

PubMed Central

Jones, Caroline H D; Neill, Sarah; Lakhanpaul, Monica; Roland, Damian; Singlehurst-Mooney, Hayley; Thompson, Matthew

2014-01-01

Objective To explore the views of parents and clinicians regarding the optimal content, format and delivery of safety netting information for acute childhood illness. Design Qualitative study including semistructured focus groups and interviews. Setting First contact care settings, community centres, children's centres and nurseries in the Midlands, UK. Participants 27 parents from a travelling community, Asian British community and white British community. Sixteen clinicians including 10 doctors and 6 nurses from a general practice surgery, an out-of-hours service and two emergency departments (paediatric and combined adult and paediatric). Results Participants described a need for safety netting to contain information on signs and symptoms of serious and common illnesses, illness management and where and when to seek help. Resources should be basic, simple to use and contain simple symbols. A key criterion was professional endorsement of resources. Internet-based information was desired which is reliable, consistent and up-to-date. Participants described a need for different types of information: that which could be delivered during consultations, as well as more general information for parents to access before consulting a healthcare professional. Face-to-face education, written materials and digital media were suggested delivery mechanisms. Audiovisual material was preferred by families with low literacy. Participants commonly suggested internet-based and phone-based resources, but the travelling community was less comfortable with these approaches. Conclusions A multifaceted and tailored approach to safety netting is needed so that effective resources are available for parents with varying information needs, literacy levels and ability to use information technology. We have identified key aspects of content, quality criteria, format and delivery mechanisms for safety netting information from the perspectives of clinicians and parents. Resources should be coproduced with parents and clinicians to ensure that they are valued and utilised by both groups. PMID:24430877

Heathlands confronting global change: drivers of biodiversity loss from past to future scenarios

PubMed Central

Fagúndez, Jaime

2013-01-01

Background Heathlands are dynamic plant communities characterized by a high cover of sclerophyllous, ericoid shrubs that develop over nutrient-poor soils. Interest in the preservation of these habitats in Europe has increased over the last decades, but over this time there has been a general decline in habitat quality, affecting community structure, ecosystem functions and biodiversity. Negative drivers that trigger these changes include land-use changes (i.e. habitat destruction and fragmentation), pollution, climate change, natural succession and human management, as well as the presence of invasive exotic species. Scope Based on recent scientific literature, the effect of each of these potential drivers on a wide set of factors, including physiological traits, species richness and diversity, community structure, ecosystem functions and soil conditions, is reviewed. The effects of these drivers are generally understood, but the direction and magnitude of factor interactions, whenever studied, have shown high variability. Conclusions Habitat loss and fragmentation affect sensitive species and ecosystem functions. The nature of the surrounding area will condition the quality of the heathland remnants by, for example, propagule pressure from invasive species. The dominant ericoid shrubs can be out-competed by vigorous perennial grasses with increased atmospheric nitrogen deposition, although interactions with climate and management practices may either counteract or enhance this process. Grazing or periodic burning promotes heath loss but site-specific combined treatments maintain species diversity and community structure. Climate change alone moderately affects plant diversity, community structure and ecosystem functions. Combined with other factors, climatic changes will condition heath development, mainly with regard to key aspects such as seed set and seedling establishment, rare species occurrence and nutrient cycling in the soil. It is essential to address the effects of not only individual factors, but their interactions, together with land-use history, on heathland development and conservation in order to predict habitat response to future scenarios. PMID:23223202

Heathlands confronting global change: drivers of biodiversity loss from past to future scenarios.

PubMed

Fagúndez, Jaime

2013-02-01

Heathlands are dynamic plant communities characterized by a high cover of sclerophyllous, ericoid shrubs that develop over nutrient-poor soils. Interest in the preservation of these habitats in Europe has increased over the last decades, but over this time there has been a general decline in habitat quality, affecting community structure, ecosystem functions and biodiversity. Negative drivers that trigger these changes include land-use changes (i.e. habitat destruction and fragmentation), pollution, climate change, natural succession and human management, as well as the presence of invasive exotic species. Based on recent scientific literature, the effect of each of these potential drivers on a wide set of factors, including physiological traits, species richness and diversity, community structure, ecosystem functions and soil conditions, is reviewed. The effects of these drivers are generally understood, but the direction and magnitude of factor interactions, whenever studied, have shown high variability. Habitat loss and fragmentation affect sensitive species and ecosystem functions. The nature of the surrounding area will condition the quality of the heathland remnants by, for example, propagule pressure from invasive species. The dominant ericoid shrubs can be out-competed by vigorous perennial grasses with increased atmospheric nitrogen deposition, although interactions with climate and management practices may either counteract or enhance this process. Grazing or periodic burning promotes heath loss but site-specific combined treatments maintain species diversity and community structure. Climate change alone moderately affects plant diversity, community structure and ecosystem functions. Combined with other factors, climatic changes will condition heath development, mainly with regard to key aspects such as seed set and seedling establishment, rare species occurrence and nutrient cycling in the soil. It is essential to address the effects of not only individual factors, but their interactions, together with land-use history, on heathland development and conservation in order to predict habitat response to future scenarios.

Toward Robust Climate Baselining: Objective Assessment of Climate Change Using Widely Distributed Miniaturized Sensors for Accurate World-Wide Geophysical Measurements

DOE R&D Accomplishments Database

Teller, E.; Leith, C.; Canavan, G.; Marion, J.; Wood, L.

2001-11-13

A gap-free, world-wide, ocean-, atmosphere-, and land surface-spanning geophysical data-set of three decades time-duration containing the full set of geophysical parameters characterizing global weather is the scientific perquisite for defining the climate; the generally-accepted definition in the meteorological community is that climate is the 30-year running-average of weather. Until such a tridecadal climate baseline exists, climate change discussions inevitably will have a semi-speculative, vs. a purely scientific, character, as the baseline against which changes are referenced will at least somewhat uncertain.

Ad hoc supervision of general practice registrars as a 'community of practice': analysis, interpretation and re-presentation.

PubMed

Clement, T; Brown, J; Morrison, J; Nestel, D

2016-05-01

General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger's (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning ('communities of practice') guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger's theory and highlights the researchers' interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others' experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings.

Distribution to the Astronomy Community of the Compressed Digitized Sky Survey

NASA Astrophysics Data System (ADS)

Postman, Marc

1996-03-01

The Space Telescope Science Institute has compressed an all-sky collection of ground-based images and has printed the data on a two volume, 102 CD-ROM disc set. The first part of the survey (containing images of the southern sky) was published in May 1994. The second volume (containing images of the northern sky) was published in January 1995. Software which manages the image retrieval is included with each volume. The Astronomical Society of the Pacific (ASP) is handling the distribution of the lOx compressed data and has sold 310 sets as of October 1996. ASP is also handling the distribution of the recently published 100x version of the northern sky survey which is publicly available at a low cost. The target markets for the 100x compressed data set are the amateur astronomy community, educational institutions, and the general public. During the next year, we plan to publish the first version of a photometric calibration database which will allow users of the compressed sky survey to determine the brightness of stars in the images.

Distribution to the Astronomy Community of the Compressed Digitized Sky Survey

NASA Technical Reports Server (NTRS)

Postman, Marc

1996-01-01

The Space Telescope Science Institute has compressed an all-sky collection of ground-based images and has printed the data on a two volume, 102 CD-ROM disc set. The first part of the survey (containing images of the southern sky) was published in May 1994. The second volume (containing images of the northern sky) was published in January 1995. Software which manages the image retrieval is included with each volume. The Astronomical Society of the Pacific (ASP) is handling the distribution of the lOx compressed data and has sold 310 sets as of October 1996. ASP is also handling the distribution of the recently published 100x version of the northern sky survey which is publicly available at a low cost. The target markets for the 100x compressed data set are the amateur astronomy community, educational institutions, and the general public. During the next year, we plan to publish the first version of a photometric calibration database which will allow users of the compressed sky survey to determine the brightness of stars in the images.

Mean-variance portfolio analysis data for optimizing community-based photovoltaic investment.

PubMed

Shakouri, Mahmoud; Lee, Hyun Woo

2016-03-01

The amount of electricity generated by Photovoltaic (PV) systems is affected by factors such as shading, building orientation and roof slope. To increase electricity generation and reduce volatility in generation of PV systems, a portfolio of PV systems can be made which takes advantages of the potential synergy among neighboring buildings. This paper contains data supporting the research article entitled: PACPIM: new decision-support model of optimized portfolio analysis for community-based photovoltaic investment [1]. We present a set of data relating to physical properties of 24 houses in Oregon, USA, along with simulated hourly electricity data for the installed PV systems. The developed Matlab code to construct optimized portfolios is also provided in . The application of these files can be generalized to variety of communities interested in investing on PV systems.

An iPad™-based picture and video activity schedule increases community shopping skills of a young adult with autism spectrum disorder and intellectual disability.

PubMed

Burckley, Elizabeth; Tincani, Matt; Guld Fisher, Amanda

2015-04-01

To evaluate the iPad 2™ with Book Creator™ software to provide visual cues and video prompting to teach shopping skills in the community to a young adult with an autism spectrum disorder and intellectual disability. A multiple probe across settings design was used to assess effects of the intervention on the participant's independence with following a shopping list in a grocery store across three community locations. Visual cues and video prompting substantially increased the participant's shopping skills within two of the three community locations, skill increases maintained after the intervention was withdrawn, and shopping skills generalized to two untaught shopping items. Social validity surveys suggested that the participant's parent and staff favorably viewed the goals, procedures, and outcomes of intervention. The iPad 2™ with Book Creator™ software may be an effective way to teach independent shopping skills in the community; additional replications are needed.

Connecting for Health Literacy: Health Information Partners

PubMed Central

Pomerantz, Karyn L.; Muhammad, Abdul-Ali; Downey, Stacey; Kind, Terry

2010-01-01

This article describes a community-based health information partnership to address health literacy and health information inequalities in marginalized communities. Public health, medical, literacy, and library practitioners promote health literacy through outreach, training, and professional development activities in community settings. They create learning environments for people to develop the necessary knowledge and skills to better understand health information and health policy so they can make decisions concerning personal and community health. Outreach activities focus on visits to neighborhood health centers, health fairs, health exhibits at union meetings and conferences; training programs involve hands-on, peer-led computer classes for people living with HIV and for the general public; and professional development programs connect librarians, health providers, public health workers, and literacy teachers in joint planning and learning. Several learners currently participate in and lead community health education programs and HIV advocacy. The coalition's strength develops from strongly shared objectives, an absence of territoriality, and a core active leadership group. PMID:18544664

Barriers and Strategies to Engaging Our Community-Based Preceptors.

PubMed

Graziano, Scott C; McKenzie, Margaret L; Abbott, Jodi F; Buery-Joyner, Samantha D; Craig, LaTasha B; Dalrymple, John L; Forstein, David A; Hampton, Brittany S; Page-Ramsey, Sarah M; Pradhan, Archana; Wolf, Abigail; Hopkins, Laura

2018-03-26

This article, from the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is a review of commonly cited barriers to recruiting and retaining community-based preceptors in undergraduate medical education and potential strategies to overcome them. Community-based preceptors have traditionally served as volunteer, nonsalaried faculty, with academic institutions relying on intrinsic teaching rewards to sustain this model. However, increasing numbers of learners, the burdens of incorporating the electronic medical record in practice, and increasing demands for clinical productivity are making recruitment and retention of community-based preceptors more challenging. General challenges to engaging preceptors, as well as those unique to women's health, are discussed. Potential solutions are reviewed, including alternative recruitment strategies, faculty development to emphasize efficient teaching practices in the ambulatory setting, offers of online educational resources, and opportunities to incorporate students in value-added roles. Through examples cited in this review, clerkship directors and medical school administrators should have a solid foundation to actively engage their community-based preceptors.

The value of teaching about geomorphology in non-traditional settings

NASA Astrophysics Data System (ADS)

Davis, R. Laurence

2002-10-01

Academics usually teach about geomorphology in the classroom, where the audience is enthusiastic, but generally small. Less traditional settings offer opportunities to reach a wider audience, one that is equally enthusiastic, given its love of geomorphic features in the National Parks, but one which has little knowledge of the science behind what they are seeing. I have "taught" geomorphology in four non-traditional settings: at a summer camp, a state wildlife refuge, on community field trips, and at meetings for clubs and government boards. This paper discusses my experiences and offers suggestions to others who may wish to follow this less-traveled educational path. As Head of Nature Programs at Camp Pemigewassett in New Hampshire, I have worked, over the last 33 years, with thousands of campers ranging from 8 to 15 years old. Our setting, in a glaciated valley on a small lake, exhibits a wide range of geomorphic features and offers many opportunities for direct learning through field investigations. I have found that even 8-year olds can do real science, if we avoid the jargon. Once "taught" they carry their knowledge about landforms and processes with them and eagerly share it with their friends and family on outings and trips, thus reaching an even wider public. Parks, wildlife refuges, nature preserves, and other similar areas generally have nature trails, often with educational information about the environment. Generally, interpretive signs are prepared by biologists and the content ignores the site's physical features, as well as the connections between ecological communities and the underlying geology and geomorphology. My students and I have addressed this situation at two places in Connecticut, one a state wildlife management area, also used for training teachers to teach Environmental Education, and the other, a town recreation area. We catalogued the geomorphic features, looked at relationships of the community level ecology to those features, and prepared interpretive signs that added this perspective to the trails. The public response has been extremely favorable. Geomorphology can also be taught by leading field trips for community organizations. I have done this twice, once for the Manchester (NH) Historical Society and once for a small watershed association. The attendance and interest surprised me. We finally had to limit the Manchester trip to one full busload (˜45) and the watershed trip, which was part of a "trails day," drew over 90 people. Finally, I have found that organizations such as Sierra Club chapters and town conservation boards are frequently looking for speakers for their periodic meetings. Why not a geomorphologist? After all, much of what conservationists do is related to what geomorphologists do. I have given several of these presentations and the receptions have always been enthusiastic. While the work involved in preparing to teach in one of these non-traditional settings is frequently substantial, the rewards are equally large. It is a way to reach masses of people who know little about the science of geomorphology and to demonstrate its importance to them. Taking our message directly to the public in these settings is an effective way to put geomorphology in the public eye.

Changes in a northwestern Florida gulf coast herpetofaunal community over a 28-y period

USGS Publications Warehouse

Dodd, C.K.; Barichivich, W.J.; Johnson, S.A.; Staiger, J.S.

2007-01-01

Population declines of amphibians and reptiles throughout the world have led to the initiation of projects to monitor their status and trends. Historical collections give an indication of which species occurred in an area at one time, although the ambiguity surrounding locations and environmental conditions associated with collection decreases the value of this information source. Resampling using the same general protocols can give valuable insights to changes in community structure. However, this is only feasible when sampling methodology and exact site locations are known. From 2002-2005 we resampled 12 sites in St. Marks National Wildlife Refuge in Florida's panhandle, an area in which intensive herpetological surveys were conducted in 1977-1979. We documented a general decrease in species richness among the diversely managed sites, changes in dominant species and diversity and an increasing trend toward homogeneity of the herpetofaunal community among habitats. Changes were attributed to four causes: 28-y of forest community succession, changes in management practices, non-detection of species due to variation in sampling conditions and a decrease in occupancy by four amphibians and three reptiles. The use of population and habitat-related indexes helped define possible influences on community change and can be used to target species for monitoring. Declines of these seven species are of concern, especially considering the protected status of the refuge and its increasing isolation as surrounding landscapes are converted to urbanized settings.

A survey of microbial community diversity in marine sediments impacted by petroleum hydrocarbons from the Gulf of Mexico and Atlantic shorelines, Texas to Florida

USGS Publications Warehouse

Lisle, John T.; Stellick, Sarah H.

2011-01-01

Microbial community genomic DNA was extracted from sediment samples collected along the Gulf of Mexico and Atlantic coasts from Texas to Florida. Sample sites were identified as being ecologically sensitive and (or) as having high potential of being impacted by Macondo-1 (M-1) well oil from the Deepwater Horizon blowout. The diversity within the microbial communities associated with the collected sediments provides a baseline dataset to which microbial community-diversity data from impacted sites could be compared. To determine the microbial community diversity in the samples, genetic fingerprints were generated and compared. Specific sequences within the community genomic DNA were first amplified using the polymerase chain reaction (PCR) with a primer set that provides possible resolution to the species level. A second nested PCR was performed on the primary PCR products using a primer set on which a GC-clamp was attached to one of the primers. The nested PCR products were separated using denaturing-gradient gel electrophoresis (DGGE) that resolves the nested PCR products based on sequence dissimilarities (or similarities), forming a genomic fingerprint of the microbial diversity within the respective samples. Samples with similar fingerprints were grouped and compared to oil-fingerprint data from the same sites (Rosenbauer and others, 2011). The microbial community fingerprints were generally grouped into sites that had been shown to contain background concentrations of non-Deepwater Horizon oil. However, these groupings also included sites where no oil signature was detected. This report represents some of the first information on naturally occurring microbial communities in sediment from shorelines along the Gulf of Mexico and Atlantic coasts from Texas to Florida.

A qualitative study of why general practitioners admit to community hospitals.

PubMed Central

Grant, James A; Dowell, Jon

2002-01-01

BACKGROUND: Intermediate care, which is provided by community hospitals, is increasingly seen as one way of reducing pressure on secondary care. However, despite evidence of wide variation, there is little literature describing how general practitioners (GPs) use these hospitals. Because of the control they have over decisions to admit, development of these units depends on the cooperation of GPs. AIM: To identify and understand the factors influencing the decision to admit to a community hospital. DESIGN OF STUDY: A qualitative interview study. SETTING: Twenty-seven practitioners from ten practices supporting five community hospitals in one region of Tayside, Scotland Secondary support was identical for all sites. METHOD: In-depth interviews were conducted with a purposive sample of GPs representing those who had the most and the least use of the five community hospitals. A qualitative anaysis was performed to determine thefactors that practitioners considered important when making decisions about admission. Results were presented to the study group for validation. RESULTS: All admissions required adequate capacity in the community hospital system. Primarily social admissions were straight forward requiring only adequate hospital nursing, and GP capacity. More typical admissions involving social and medical needs required consideration of the professional concerns and the personal influences on the doctor as well as the potential benefits to the patient. As medical complexity increased the doctor's comfort/discomfort became the deciding factor. CONCLUSION: Provided there was adequate capacity, the GPs perceived the level of comfort to be the prime determinant of which patients are admitted to community hospitals and which are referred to secondary care. PMID:12171220

Representation of the Auroral and Polar Ionosphere in the International Reference Ionosphere (IRI)

NASA Technical Reports Server (NTRS)

Bilitza, Dieter; Reinisch, Bodo

2013-01-01

This issue of Advances in Space Research presents a selection of papers that document the progress in developing and improving the International Reference Ionosphere (IRI), a widely used standard for the parameters that describe the Earths ionosphere. The core set of papers was presented during the 2010 General Assembly of the Committee on Space Research in Bremen, Germany in a session that focused on the representation of the auroral and polar ionosphere in the IRI model. In addition, papers were solicited and submitted from the scientific community in a general call for appropriate papers.

Current status of the Essential Variables as an instrument to assess the Earth Observation Networks in Europe

NASA Astrophysics Data System (ADS)

Blonda, Palma; Maso, Joan; Bombelli, Antonio; Plag, Hans Peter; McCallum, Ian; Serral, Ivette; Nativi, Stefano Stefano

2016-04-01

ConnectinGEO (Coordinating an Observation Network of Networks EnCompassing saTellite and IN-situ to fill the Gaps in European Observations" is an H2020 Coordination and Support Action with the primary goal of linking existing Earth Observation networks with science and technology (S&T) communities, the industry sector, the Group on Earth Observations (GEO), and Copernicus. The project will end in February 2017. Essential Variables (EVs) are defined by ConnectinGEO as "a minimal set of variables that determine the system's state and developments, are crucial for predicting system developments, and allow us to define metrics that measure the trajectory of the system". . Specific application-dependent characteristics, such as spatial and temporal resolution of observations and data quality thresholds, are not generally included in the EV definition. This definition and the present status of EV developments in different societal benefit areas was elaborated at the ConnectinGEO workshop "Towards a sustainability process for GEOSS Essential Variables (EVs)," which was held in Bari on June 11-12, 2015 (http://www.gstss.org/2015_Bari/). Presentations and reports contributed by a wide range of communities provided important inputs from different sectors for assessing the status of the EV development. In most thematic areas, the development of sets of EVs is a community process leading to an agreement on what is essential for the goals of the community. While there are many differences across the communities in the details of the criteria, methodologies and processes used to develop sets of EVs, there is also a considerable common core across the communities, particularly those with a more advanced discussion. In particular, there is some level of overlap in different topics (e.g., Climate and Water), and there is a potential to develop an integrated set of EVs common to several thematic areas as well as specific ones that satisfy only one community. The thematic areas with a more mature development of EV lists are Climate (ECV), Ocean (EOV) and Biodiversity (EBV). Water is also developing a set of EVs in GEOSS. Agriculture is working with a common set of variables that can be considered essential to them such as Crop Area, Crop Type, Crop Condition, etc.. More work is required for an agreement on other sets of EVs for Disasters, Health and Ecosystems. Being cross-domain topics, these areas can make use of existing sets of EVs (such as ECVs, EOVs and EBVs) complemented by socioeconomic variables that can help to characterize services (e.g., ecosystem services) to human societies. Renewable energy also makes use of the ECVs but there is a need for additional ones: solar surface irradiance and wind at different heights are good candidates to explore. ConnectinGEO will link with Climate, Ocean and Biodiversity communities and support Water, Agriculture, Renewable Energy, Health, Disasters and Ecosystems to make progress in the EV development by stimulating the debate in their respective international forums (mainly in GEOSS). The final objective is to foster EV extraction from the integrated use of in-situ and satellite Earth Observation data.

Effectiveness of implementation strategies for clinical guidelines to community pharmacy: a systematic review.

PubMed

Watkins, Kim; Wood, Helen; Schneider, Carl R; Clifford, Rhonda

2015-10-29

The clinical role of community pharmacists is expanding, as is the use of clinical guidelines in this setting. However, it is unclear which strategies are successful in implementing clinical guidelines and what outcomes can be achieved. The aim of this systematic review is to synthesise the literature on the implementation of clinical guidelines to community pharmacy. The objectives are to describe the implementation strategies used, describe the resulting outcomes and to assess the effectiveness of the strategies. A systematic search was performed in six electronic databases (Medline, EMBASE, CINAHL, Web of Science, Informit, Cochrane Library) for relevant articles. Studies were included if they reported on clinical guidelines implementation strategies in the community pharmacy setting. Two researchers completed the full-search strategy, data abstraction and quality assessments, independently. A third researcher acted as a moderator. Quality assessments were completed with three validated tools. A narrative synthesis was performed to analyse results. A total of 1937 articles were retrieved and the titles and abstracts were screened. Full-text screening was completed for 36 articles resulting in 19 articles (reporting on 22 studies) included for review. Implementation strategies were categorised according to a modified version of the EPOC taxonomy. Educational interventions were the most commonly utilised strategy (n = 20), and computerised decision support systems demonstrated the greatest effect (n = 4). Most studies were multifaceted and used more than one implementation strategy (n = 18). Overall outcomes were moderately positive (n = 17) but focused on process (n = 22) rather than patient (n = 3) or economic outcomes (n = 3). Most studies (n = 20) were rated as being of low methodological quality and having low or very low quality of evidence for outcomes. Studies in this review did not generally have a well thought-out rationale for the choice of implementation strategy. Most utilised educational strategies, but the greatest effect on outcomes was demonstrated using computerised clinical decision support systems. Poor methodology, in the majority of the research, provided insufficient evidence to be conclusive about the best implementation strategies or the benefit of clinical guidelines in this setting. However, the generally positive outcomes across studies and strategies indicate that implementing clinical guidelines to community pharmacy might be beneficial. Improved methodological rigour in future research is required to strengthen the evidence for this hypothesis. PROSPERO 2012: CRD42012003019 .

Interprofessional communication between community pharmacists and general practitioners: a qualitative study.

PubMed

Weissenborn, Marina; Haefeli, Walter E; Peters-Klimm, Frank; Seidling, Hanna M

2017-06-01

Background While collaboration between community pharmacists (CPs) and general practitioners (GPs) is essential to provide comprehensive patient care, their communication often is scarce and hampered by multiple barriers. Objective We aimed to assess both professions' perceptions of interprofessional communication with regard to content and methods of communication as a basis to subsequently develop best-practice recommendations for information exchange. Setting Ambulatory care setting in Germany. Method CPs and GPs shared their experience in focus groups and in-depth interviews which were conducted using a semi-structured interview guideline. Transcribed recordings were assessed using qualitative content analysis according to Mayring. Main outcome measure Specification of existing barriers, CPs'/GPs' general perceptions of interprofessional communication and similarities and differences regarding prioritization of specific information items and how to best communicate with each other. Results Four focus groups and fourteen interviews were conducted. Seven internal (e.g. professions were not personally known to one another) and nine external barriers (e.g. mutual accessibility) were identified. Ten organizational, eight medication-related, and four patient-related information items were identified requiring interprofessional communication. Their relevance varied between the professions, e.g. CPs rated organizational issues higher than GPs. Both professions indicated communication via phone to be the most frequently used method of communication. Conclusion CPs and GPs opinions often differ. However, communication between CPs and GPs is perceived as crucial suggesting that a future concept has to offer standardized recommendations, while leaving CPs and GPs room to adjust it to their individual needs.

Treatment of Individuals with Borderline Personality Disorder Using Dialectical Behavior Therapy in a Community Mental Health Setting: Clinical Application and a Preliminary Investigation

ERIC Educational Resources Information Center

Ben-Porath, Denise D.; Peterson, Gregory A.; Smee, Jacqueline

2004-01-01

This article describes an effort to implement and examine dialectical behavior therapy's (DBT) effectiveness in a community mental health setting. Modifications made to address unique aspects of community mental health settings are described. Barriers encountered in implementation of DBT treatment in community mental health settings, such as staff…

A Systematic Narrative Review of Effects of Community-Based Intervention on Rates of Organ Donor Registration.

PubMed

Golding, Sarah Elizabeth; Cropley, Mark

2017-09-01

The demand for organ donation is increasing worldwide. One possible way of increasing the pool of potential posthumous donors is to encourage more members of the general public to join an organ donor registry. A systematic review was conducted to investigate the effectiveness of psychological interventions designed to increase the number of individuals in the community who register as organ donors. PsycINFO and PubMed databases were searched. No date limits were set. Randomized and nonrandomized controlled trials exploring the effects of community-based interventions on organ donor registration rates were included. Methodological quality was assessed using the "Quality Assessment Tool for Quantitative Studies." Twenty-four studies met the inclusion criteria; 19 studies found a positive intervention effect on registration. Only 8 studies were assessed as having reasonable methodological robustness. A narrative synthesis was conducted. Factors influencing registration rates include providing an immediate registration opportunity and using brief interventions to challenge misconceptions and concerns about organ donation. Community-based interventions can be effective at increasing organ donor registrations among the general public. Factors that may increase effectiveness include brief interventions to address concerns and providing an immediate registration opportunity. Particular consideration should be paid to the fidelity of intervention delivery. Protocol registration number: CRD42014012975.

Association of Resident Coverage with Cost, Length of Stay, and Profitability at a Community Hospital

PubMed Central

Shine, Daniel; Beg, Sumbul; Jaeger, Joseph; Pencak, Dorothy; Panush, Richard

2001-01-01

OBJECTIVE The effect of care by medical residents on hospital length of stay (LOS), indirect costs, and reimbursement was last examined across a range of illnesses in 1981; the issue has never been examined at a community hospital. We studied resource utilization and reimbursement at a community hospital in relation to the involvement of medical residents. DESIGN This nonrandomized observational study compared patients discharged from a general medicine teaching unit with those discharged from nonteaching general medical/surgical units. SETTING A 620-bed community teaching hospital with a general medicine teaching unit (resident care) and several general medicine nonteaching units (no resident care). PATIENTS All medical discharges between July 1998 and February 1999, excluding those from designated subspecialty and critical care units. MEASUREMENTS AND MAIN RESULTS Endpoints included mean LOS in excess of expected LOS, mean cost in excess of expected mean payments, and mean profitability (payments minus total costs). Observed values were obtained from the hospital's database and expected values from a proprietary risk–cost adjustment program. No significant difference in LOS between 917 teaching-unit patients and 697 nonteaching patients was demonstrated. Costs averaged $3,178 (95% confidencence interval (CI) ± $489) less than expected among teaching-unit patients and $4,153 (95% CI ± $422) less than expected among nonteaching-unit patients. Payments were significantly higher per patient on the teaching unit than on the nonteaching units, and as a result mean, profitability was higher: $848 (95% CI ± $307) per hospitalization for teaching-unit patients and $451 (95% CI ± $327) for patients on the nonteaching units. Teaching-unit patients of attendings who rarely admitted to the teaching unit (nonteaching attendings) generated an average profit of $1,299 (95% CI ± $613), while nonteaching patients of nonteaching attendings generated an average profit of $208 (95% CI ± $437). CONCLUSIONS Resident care at our community teaching hospital was associated with significantly higher costs but also with higher payments and greater profitability. PMID:11251744

Community structural characteristics and the adoption of fluoridation.

PubMed Central

Smith, R A

1981-01-01

A study of community structural characteristics associated with fluoridation outcomes was conducted in 47 communities. A three-part outcome distinction was utilized: communities never having publicly considered the fluoridation issue, those rejecting it, and those accepting it. The independent variables reflect the complexity of the community social and economic structure, social integration, and the centralization of authority. Results of mean comparisons show statistically significant differences between the three outcome types on the independent variables. A series of discriminant analyses provides furtheor evidence of how the independent variables are associated with each outcome type. Non-considering communities are shown to be low in complexity, and high in social integration and the centralization of governmental authority. Rejecters are shown to be high in complexity, but low in social integration and centralized authority. Adopters are relatively high on all three sets of variables. Theretical reasoning is provided to support the hypothesis and why these results are expected. The utility of these results and structural explanations in general are discussed, especially for public/environmental health planning and political activities. PMID:7258427

Implementing community-based provider participation in research: an empirical study.

PubMed

Teal, Randall; Bergmire, Dawn M; Johnston, Matthew; Weiner, Bryan J

2012-05-08

Since 2003, the United States National Institutes of Health (NIH) has sought to restructure the clinical research enterprise in the United States by promoting collaborative research partnerships between academically-based investigators and community-based physicians. By increasing community-based provider participation in research (CBPPR), the NIH seeks to advance the science of discovery by conducting research in clinical settings where most people get their care, and accelerate the translation of research results into everyday clinical practice. Although CBPPR is seen as a promising strategy for promoting the use of evidence-based clinical services in community practice settings, few empirical studies have examined the organizational factors that facilitate or hinder the implementation of CBPPR. The purpose of this study is to explore the organizational start-up and early implementation of CBPPR in community-based practice. We used longitudinal, case study research methods and an organizational model of innovation implementation to theoretically guide our study. Our sample consisted of three community practice settings that recently joined the National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP) in the United States. Data were gathered through site visits, telephone interviews, and archival documents from January 2008 to May 2011. The organizational model for innovation implementation was useful in identifying and investigating the organizational factors influencing start-up and early implementation of CBPPR in CCOP organizations. In general, the three CCOP organizations varied in the extent to which they achieved consistency in CBPPR over time and across physicians. All three CCOP organizations demonstrated mixed levels of organizational readiness for change. Hospital management support and resource availability were limited across CCOP organizations early on, although they improved in one CCOP organization. As a result of weak IPPs, all three CCOPs created a weak implementation climate. Patient accrual became concentrated over time among those groups of physicians for whom CBPPR exhibited a strong innovation-values fit. Several external factors influenced innovation use, complicating and enriching our intra-organizational model of innovation implementation. Our results contribute to the limited body of research on the implementation of CBPPR. They inform policy discussions about increasing and sustaining community clinician involvement in clinical research and expand on theory about organizational determinants of implementation effectiveness.

Promoting community participation in priority setting in district health systems: experiences from Mbarali district, Tanzania

PubMed Central

Kamuzora, Peter; Maluka, Stephen; Ndawi, Benedict; Byskov, Jens; Hurtig, Anna-Karin

2013-01-01

Background Community participation in priority setting in health systems has gained importance all over the world, particularly in resource-poor settings where governments have often failed to provide adequate public-sector services for their citizens. Incorporation of public views into priority setting is perceived as a means to restore trust, improve accountability, and secure cost-effective priorities within healthcare. However, few studies have reported empirical experiences of involving communities in priority setting in developing countries. The aim of this article is to provide the experience of implementing community participation and the challenges of promoting it in the context of resource-poor settings, weak organizations, and fragile democratic institutions. Design Key informant interviews were conducted with the Council Health Management Team (CHMT), community representatives, namely women, youth, elderly, disabled, and people living with HIV/AIDS, and other stakeholders who participated in the preparation of the district annual budget and health plans. Additionally, minutes from the Action Research Team and planning and priority-setting meeting reports were analyzed. Results A number of benefits were reported: better identification of community needs and priorities, increased knowledge of the community representatives about priority setting, increased transparency and accountability, promoted trust among health systems and communities, and perceived improved quality and accessibility of health services. However, lack of funds to support the work of the selected community representatives, limited time for deliberations, short notice for the meetings, and lack of feedback on the approved priorities constrained the performance of the community representatives. Furthermore, the findings show the importance of external facilitation and support in enabling health professionals and community representatives to arrive at effective working arrangement. Conclusion Community participation in priority setting in developing countries, characterized by weak democratic institutions and low public awareness, requires effective mobilization of both communities and health systems. In addition, this study confirms that community participation is an important element in strengthening health systems. PMID:24280341

Social capital and self-reported general and mental health in nine Former Soviet Union countries.

PubMed

Goryakin, Yevgeniy; Suhrcke, Marc; Rocco, Lorenzo; Roberts, Bayard; McKee, Martin

2014-01-01

Social capital has been proposed as a potentially important contributor to health, yet most of the existing research tends to ignore the challenge of assessing causality in this relationship. We deal with this issue by employing various instrumental variable estimation techniques. We apply the analysis to a set of nine former Soviet countries, using a unique multi-country household survey specifically designed for this region. Our results confirm that there appears to be a causal association running from several dimensions of individual social capital to general and mental health. Individual trust appears to be more strongly related to general health, while social isolation- to mental health. In addition, social support and trust seem to be more important determinants of health than the social capital dimensions that facilitate solidarity and collective action. Our findings are remarkably robust to a range of different specifications, including the use of instrumental variables. Certain interaction effects are also found: for instance, untrusting people who live in communities with higher aggregate level of trust are even less likely to experience good health than untrusting people living in the reference communities.

Income Levels and Response to Contingency Management for Smoking Cessation.

PubMed

López-Núñez, Carla; Secades-Villa, Roberto; Peña-Suárez, Elsa; Fernández-Artamendi, Sergio; Weidberg, Sara

2017-06-07

Contingency management (CM) has demonstrated its efficacy in treating many drug addictions, including nicotine. However, one of the most commonly perceived limitations with regard to its dissemination into community settings is whether this protocol could be equally effective for treating patients across different income levels. This study aimed to examine whether individuals' income levels affect treatment success in a cognitive behavioral treatment (CBT) that included a voucher-based CM protocol for smoking cessation. A total of 92 treatment-seeking smokers in a community setting were randomly assigned to a CBT group (N = 49) or to a CBT plus CM group (N = 43). The CM procedure included a voucher program through which smoking abstinence was reinforced on a schedule of escalating magnitude of reinforcement with a reset contingency. We analyzed the impact of self-reported monthly income, alone and in combination with treatment condition, on short-term (treatment retention) and long-term (self-reported number of days of continuous smoking abstinence at 6-month follow-up) results. Income had no effect on treatment retention and continuous abstinence outcomes at 6-month follow-up in either treatment condition. Treatment modality emerged as the only significant predictor of treatment success. Our findings suggest that treatment-seeking smokers from the general population respond equally well to CM regardless of their income levels. The results of this randomized controlled trial support the generalizability of this evidenced-based program into community settings.

Residency exposures and anticipated future involvement in community settings.

PubMed

Goldshore, Matthew A; Solomon, Barry S; Downs, Stephen M; Pan, Richard; Minkovitz, Cynthia S

2014-01-01

To assess how exposures to community activities in residency impact anticipated future involvement in community child health settings. Prospective cohort study of pediatric residents from 10 programs (12 sites) who completed training between 2003 and 2009. Residents reported annual participation for ≥ 8 days in each of 7 community activities (eg, community settings, child health advocacy) in the prior year. At the start and end of residency, residents reported anticipated involvement in 10 years in 8 community settings (eg, school, shelter). Anticipated involvement was dichotomized: moderate/substantial ("high") versus none/limited ("low"). Logistic regression modeled whether residency exposures independently influenced anticipated future involvement at the end of residency. A total of 683 residents completed surveys at the start and end of residency (66.8% participation). More than half of trainees reported ≥ 8 days' of involvement in community settings (65.6%) or child health advocacy (53.6%) in residency. Fewer anticipated high involvement in at least 1 community setting at the end of residency than at the start (65.5% vs 85.6%, P < .001). Participation in each community activity mediated but did not moderate relations between anticipated involvement at the start and end of residency. In multivariate models, exposure to community settings in residency was associated with anticipated involvement at end of residency (adjusted odds ratio 1.5; 95% confidence interval 1.2, 2.0). No other residency exposures were associated. Residents who anticipate high involvement in community pediatrics at the start of residency participate in related opportunities in training. Exposure to community settings during residency may encourage community involvement after training. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

An Evaluation of the Generalization and Maintenance Outcomes of a Competency-Based Training Program Aligned with the BACB® Registered Behavior Technician™ Task List

ERIC Educational Resources Information Center

Forte, Solandy

2017-01-01

It is often necessary for the behavior analyst practitioner to work across a variety of settings, including home, school, and community, in which it is common practice for those practitioners to provide training to caregivers and direct-care staff, who may have limited knowledge and experience within the field of applied behavior analysis. A…

FDR's First Inaugural Address: Declaring "War" on the Great Depression. The Constitution Community: The Great Depression and World War II (1929-1945).

ERIC Educational Resources Information Center

Lawlor, John M., Jr.

By late winter 1933, the United States had already endured more than 3 years of economic depression. During the previous summer, the Democratic Party platform had unveiled a generalized plan for economic recovery. President Franklin D. Roosevelt set about to prepare the nation to accept expansion of federal power since he recognized that the…

Helpful advice and hidden expertize: pharmacy users' experiences of community pharmacy accessibility.

PubMed

Lindsey, Laura; Husband, Andy; Steed, Liz; Walton, Robert; Todd, Adam

2017-09-01

In recent years community pharmacies have emerged as strategically important settings to deliver services aimed at promoting public health. In order to develop evidence-based approaches to public health interventions that exploit the unique accessibility of community pharmacies, it is important to determine how people experience care in this context. This study, therefore, aimed to describe how care is perceived and experienced in community pharmacies with particular focus on community pharmacy access. In-depth semi-structured interviews were used to explore the perceptions and experiences' of people using community pharmacies. A total of 30 participants were interviewed. Themes specifically emerged in relation to community pharmacy access; these fell into four main categories: relationships; time; lack of awareness; and empowerment. The experience of developing a trusting relationship with the pharmacist is an important consideration in the context of community pharmacy accessibility. This could be an important consideration when a person uses a community pharmacy to access a public health service. There is also a perceived lack of awareness among the general public about the extended role of community pharmacy; this is a potential barrier toward people using them. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

The SAMPEX Data Center and User Interface for the Heliophysics Community

NASA Astrophysics Data System (ADS)

Davis, A. J.; Kanekal, S. G.; Looper, M. D.; Mazur, J. E.

2012-12-01

The Solar, Anomalous, Magnetospheric Particle Explorer (SAMPEX) was the first of NASA's Small Explorer (SMEX) series. SAMPEX was launched July 3, 1992 into a 520 by 670 km orbit at 82 degrees inclination. SAMPEX carries four instruments designed to study energetic particles of solar, interplanetary, and magnetospheric origin, as well as "anomalous" and galactic cosmic rays. As an outcome of the Senior Review process, the NASA SAMPEX science mission ended on June 30, 2004, leaving a 12-year continuous record of observations. (The spacecraft and instruments are still operating and returning science data under a partnership between NASA and the Aerospace Corporation). SAMPEX was launched before the development of the WWW and implementation of NASA's open data policy. This, and the complexity of the data analysis have made it difficult for the general community to make full use of the SAMPEX science data set. The SAMPEX Data Center remedies the situation. The data center set-up and operation was funded for 3 years by NASA, and it remains in operation. The goals of the data center are to enable community access to the full SAMPEX data set by developing an up-to-date, flexible web-based system, and to provide for the eventual permanent archiving of this version of the SAMPEX data set at the NSSDC. Knowledgeable members of the SAMPEX science team have prepared the data, and members of the ACE Science Center at Caltech are involved in maintaining the data distribution pipeline and user interface. The system is modeled in part on the ACE Science Center, but enhanced to accommodate the more-complex SAMPEX data set. We will describe the current status of the SAMPEX Data Center, the user interface, and the contents of the data that are available.

The SAMPEX Data Center and User Interface for the SEC Community

NASA Astrophysics Data System (ADS)

Davis, A. J.; Mason, G. M.; Walpole, P.; von Rosenvinge, T. T.; Looper, M. D.; Blake, J. B.; Mazur, J. E.; Stone, E. C.; Leske, R. A.; Labrador, A. W.; Mewaldt, R. A.; Kanekal, S. G.; Baker, D. N.; Li, X.; Klecker, B.

2005-05-01

The Solar, Anomalous, Magnetospheric Particle Explorer (SAMPEX) was the first of NASA's Small Explorer (SMEX) series. SAMPEX was launched July 3, 1992 into a 520 by 670 km orbit at 82 degrees inclination. SAMPEX carries four instruments designed to study energetic particles of solar, interplanetary, and magnetospheric origin, as well as "anomalous" and galactic cosmic rays. As an outcome of the Senior Review process, the NASA SAMPEX science mission ended on June 30, 2004, leaving a 12-year continuous record of observations. (The spacecraft and instruments are still operating and returning science data for a 1-year trial period under a partnership between NASA and the Aerospace Corporation). SAMPEX was launched before the development of the WWW and implementation of NASA's open data policy. This, and the complexity of the data analysis have made it difficult for the general community to make full use of the SAMPEX science data set. The SAMPEX Data Center will remedy the situation. The data center set-up and operation is funded for 3 years by NASA. The goals of the data center are to enable community access to the full SAMPEX data set by developing an up-to-date, flexible web-based system, and to provide for the eventual permanent archiving of this version of the SAMPEX data set at the NSSDC. Knowledgeable members of the SAMPEX science team are preparing the data, and members of the ACE Science Center at Caltech are involved in developing the data distribution pipeline and user interface. The system is modeled in part on the ACE Science Center, but enhanced to accommodate the more-complex SAMPEX data set. We will describe the current status of the SAMPEX Data Center development, the user interface, and the contents of the data that will be made available.

Ageism, Aging and HIV: Community Responses to Prevention, Treatment, Care and Support.

PubMed

DeMarco, Rosanna F; Brennan-Ing, Mark; Sprague, Courtenay; Brown, Shelley M

Ageism, in the form of prejudice, stereotyping, and discrimination targeting older adults, represents a barrier to addressing the graying of the HIV epidemic. There is widespread misperception on the part of older adults themselves, as well as service providers and society in general that HIV risk is low as one ages. In addition, internalized ageism may play a role in poorer physical and mental health outcomes, as the negative stereotypes associated with aging become a self-fulfilling prophecy. A number of steps can be taken to address HIV and aging in the context of ageism with regard to: prevention, education, and outreach; treatment guidelines for older adults with HIV; funding to address the aging of the epidemic; engagement of communities, health and social service organizations, and other providers around mental health and social support, and addressing the needs of special populations. Caring for an aging population with HIV represents a challenge, which is exacerbated in low and/or middle-income countries that typically lack the infrastructure of high resource settings. How we address the aging-related issues of the HIV epidemic across regions and settings could serve as a model in dealing with aging in our society in general regardless of HIV status. © 2017 S. Karger AG, Basel.

Rapid quantitative chemical mapping of surfaces with sub-2 nm resolution

NASA Astrophysics Data System (ADS)

Lai, Chia-Yun; Perri, Saverio; Santos, Sergio; Garcia, Ricardo; Chiesa, Matteo

2016-05-01

We present a theory that exploits four observables in bimodal atomic force microscopy to produce maps of the Hamaker constant H. The quantitative H maps may be employed by the broader community to directly interpret the high resolution of standard bimodal AFM images as chemical maps while simultaneously quantifying chemistry in the non-contact regime. We further provide a simple methodology to optimize a range of operational parameters for which H is in the closest agreement with the Lifshitz theory in order to (1) simplify data acquisition and (2) generalize the methodology to any set of cantilever-sample systems.We present a theory that exploits four observables in bimodal atomic force microscopy to produce maps of the Hamaker constant H. The quantitative H maps may be employed by the broader community to directly interpret the high resolution of standard bimodal AFM images as chemical maps while simultaneously quantifying chemistry in the non-contact regime. We further provide a simple methodology to optimize a range of operational parameters for which H is in the closest agreement with the Lifshitz theory in order to (1) simplify data acquisition and (2) generalize the methodology to any set of cantilever-sample systems. Electronic supplementary information (ESI) available. See DOI: 10.1039/c6nr00496b

A Step towards a Sharable Community Knowledge Base for WRF Settings -Developing a WRF Setting Methodology based on a case study in a Torrential Rainfall Event

NASA Astrophysics Data System (ADS)

CHU, Q.; Xu, Z.; Zhuo, L.; Han, D.

2016-12-01

Increased requirements for interactions between different disciplines and readily access to the numerical weather forecasting system featured with portability and extensibility have made useful contribution to the increases of downstream model users in WRF over recent years. For these users, a knowledge base classified by the representative events would be much helpful. This is because the determination of model settings is regarded as the most important steps in WRF. However, such a process is generally time-consuming, even if with a high computational platform. As such, we propose a sharable proper lookup table on WRF domain settings and corresponding procedures based on a representative torrential rainfall event in Beijing, China. It has been found that WRF's simulations' drift away from the input lateral boundary conditions can be significantly reduced with the adjustment of the domain settings. Among all the impact factors, the placement of nested domain can not only affect the moving speed and angle of the storm-center, but also the location and amount of heavy-rain-belt which can only be detected with adjusted spatial resolutions. Spin-up time is also considered in the model settings, which is demonstrated to have the most obvious influence on the accuracy of the simulations. This conclusion is made based on the large diversity of spatial distributions of precipitation, in terms of the amount of heavy rain varied from -30% to 58% among each experiment. After following all the procedures, the variations of domain settings have minimal effect on the modeling and show the best correlation (larger than 0.65) with fusion observations. So the model settings, including domain size covering the greater Beijing area, 1:5:5 downscaling ratio, 57 vertical levels with top of 50hpa and 60h spin-up time, are found suitable for predicting the similar convective torrential rainfall event in Beijing area. We hope that the procedure for building the community WRF knowledge base in this paper would be helpful to peer-researchers and operational communities by saving them from repeating each other's work. More importantly, the results by studying different events and locations could enrich this community knowledge base to benefit WRF users around the world in the future.

Are community-living and institutionalized dementia patients cared for differently? Evidence on service utilization and costs of care from German insurance claims data

PubMed Central

2013-01-01

Background Dementia patients are often cared for in institutional arrangements, which are associated with substantial spending on professional long-term care services. Nevertheless, there is little evidence on the exact cost differences between community-based and institutional dementia care, especially when it comes to the distinct health care services. Adopting the perspective of the German social security system, which combines Statutory Health Insurance and Compulsory Long-Term Care Insurance (payer perspective), our study aimed to compare community-living and institutionalized dementia patients regarding their health care service utilization profiles and to contrast the respective expenditures. Methods We analysed 2006 claims data for 2,934 institutionalized and 5,484 community-living individuals stratified by so-called care levels, which reflect different needs for support in activities of daily living. Concordant general linear models adjusting for clinical and demographic differences were run for each stratum separately to estimate mean per capita utilization and expenditures in both settings. Subsequently, spending for the community-living and the institutionalized population as a whole was compared within an extended overall model. Results Regarding both settings, health and long-term care expenditures rose the higher the care level. Thus, long-term care spending was always increased in nursing homes, but health care spending was comparable. However, the underlying service utilization profiles differed, with nursing home residents receiving more frequent visits from medical specialists but fewer in-hospital services and anti-dementia drug prescriptions. Altogether, institutional care required additional yearly per capita expenses of ca. €200 on health and ca. €11,200 on long-term care. Conclusion Community-based dementia care is cost saving from the payer perspective due to substantially lower long-term care expenditures. Health care spending is comparable but community-living and institutionalized individuals present characteristic service utilization patterns. This apparently reflects the existence of setting-specific care strategies. However, the bare economic figures do not indicate whether these different concepts affect the quality of care provision and disregard patient preferences and caregiver-related aspects. Hence, additional research combining primary and secondary data seems to be required to foster both, sound allocation of scarce resources and the development of patient-centred dementia care in each setting. PMID:23286826

Are community-living and institutionalized dementia patients cared for differently? Evidence on service utilization and costs of care from German insurance claims data.

PubMed

Schwarzkopf, Larissa; Menn, Petra; Leidl, Reiner; Graessel, Elmar; Holle, Rolf

2013-01-03

Dementia patients are often cared for in institutional arrangements, which are associated with substantial spending on professional long-term care services. Nevertheless, there is little evidence on the exact cost differences between community-based and institutional dementia care, especially when it comes to the distinct health care services. Adopting the perspective of the German social security system, which combines Statutory Health Insurance and Compulsory Long-Term Care Insurance (payer perspective), our study aimed to compare community-living and institutionalized dementia patients regarding their health care service utilization profiles and to contrast the respective expenditures. We analysed 2006 claims data for 2,934 institutionalized and 5,484 community-living individuals stratified by so-called care levels, which reflect different needs for support in activities of daily living. Concordant general linear models adjusting for clinical and demographic differences were run for each stratum separately to estimate mean per capita utilization and expenditures in both settings. Subsequently, spending for the community-living and the institutionalized population as a whole was compared within an extended overall model. Regarding both settings, health and long-term care expenditures rose the higher the care level. Thus, long-term care spending was always increased in nursing homes, but health care spending was comparable. However, the underlying service utilization profiles differed, with nursing home residents receiving more frequent visits from medical specialists but fewer in-hospital services and anti-dementia drug prescriptions. Altogether, institutional care required additional yearly per capita expenses of ca. €200 on health and ca. €11,200 on long-term care. Community-based dementia care is cost saving from the payer perspective due to substantially lower long-term care expenditures. Health care spending is comparable but community-living and institutionalized individuals present characteristic service utilization patterns. This apparently reflects the existence of setting-specific care strategies. However, the bare economic figures do not indicate whether these different concepts affect the quality of care provision and disregard patient preferences and caregiver-related aspects. Hence, additional research combining primary and secondary data seems to be required to foster both, sound allocation of scarce resources and the development of patient-centred dementia care in each setting.

Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives

PubMed Central

Morecroft, Charles W; Mackridge, Adam J; Stokes, Elizabeth C; Gray, Nicola J; Wilson, Sarah E; Ashcroft, Darren M; Mensah, Noah; Pickup, Graham B

2015-01-01

Objective To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Design Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October–November 2012 and April 2013); interviews with CPs (February–April 2013); follow-up interviews with patients (April–May 2013); interactive feedback sessions with general practice teams (October–November 2013). Setting 22 community pharmacies and 6 general practices in Northwest England. Participants 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Results Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were ‘loaned’ in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. Conclusions CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with ongoing optimisation of repeat prescribing. PMID:26163029

Memory Complaints Associated with Seeking Clinical Care

PubMed Central

Pires, Carolina; Silva, Dina; Maroco, João; Ginó, Sandra; Mendes, Tiago; Schmand, Ben A.; Guerreiro, Manuela; de Mendonça, Alexandre

2012-01-01

Diagnosis of mild cognitive impairment relies on the presence of memory complaints. However, memory complaints are very frequent in healthy people. The objective of this study was to determine the severity and type of memory difficulties presented by elderly patients who seek for clinical help, as compared to the memory difficulties reported by subjects in the community. Assessment of subjective memory complaints was done with the subjective memory complaints scale (SMC). The mini-mental state examination was used for general cognitive evaluation and the geriatric depression scale for the assessment of depressive symptoms. Eight-hundred and seventy-one nondemented subjects older than 50 years were included. Participants in the clinical setting had a higher total SMC score (10.3 ± 4.2) than those in the community (5.1 ± 3.0). Item 3 of the SMC, Do you ever forget names of family members or friends? contributed significantly more to the variance of the total SMC score in the clinical sample (18%) as compared to the community sample (11%). Forgetting names of family members or friends plays an important role in subjective memory complaints in the clinical setting. This symptom is possibly perceived as particularly worrisome and likely drives people to seek for clinical help. PMID:22536537

Outcome assessment via handheld computer in community mental health: consumer satisfaction and reliability.

PubMed

Goldstein, Lizabeth A; Connolly Gibbons, Mary Beth; Thompson, Sarah M; Scott, Kelli; Heintz, Laura; Green, Patricia; Thompson, Donald; Crits-Christoph, Paul

2011-07-01

Computerized administration of mental health-related questionnaires has become relatively common, but little research has explored this mode of assessment in "real-world" settings. In the current study, 200 consumers at a community mental health center completed the BASIS-24 via handheld computer as well as paper and pen. Scores on the computerized BASIS-24 were compared with scores on the paper BASIS-24. Consumers also completed a questionnaire which assessed their level of satisfaction with the computerized BASIS-24. Results indicated that the BASIS-24 administered via handheld computer was highly correlated with pen and paper administration of the measure and was generally acceptable to consumers. Administration of the BASIS-24 via handheld computer may allow for efficient and sustainable outcomes assessment, adaptable research infrastructure, and maximization of clinical impact in community mental health agencies.

Mean-variance portfolio analysis data for optimizing community-based photovoltaic investment

PubMed Central

Shakouri, Mahmoud; Lee, Hyun Woo

2016-01-01

The amount of electricity generated by Photovoltaic (PV) systems is affected by factors such as shading, building orientation and roof slope. To increase electricity generation and reduce volatility in generation of PV systems, a portfolio of PV systems can be made which takes advantages of the potential synergy among neighboring buildings. This paper contains data supporting the research article entitled: PACPIM: new decision-support model of optimized portfolio analysis for community-based photovoltaic investment [1]. We present a set of data relating to physical properties of 24 houses in Oregon, USA, along with simulated hourly electricity data for the installed PV systems. The developed Matlab code to construct optimized portfolios is also provided in Supplementary materials. The application of these files can be generalized to variety of communities interested in investing on PV systems. PMID:26937458

Costs of Promoting Exclusive Breastfeeding at Community Level in Three Sites in South Africa

PubMed Central

Nkonki, Lungiswa Leonora; Daviaud, Emmanuelle; Jackson, Debra; Chola, Lumbwe; Doherty, Tanya; Chopra, Mickey; Robberstad, Bjarne

2014-01-01

Background Community-based peer support has been shown to be effective in improving exclusive breastfeeding rates in a variety of settings. Methods We conducted a cost analysis of a community cluster randomised-controlled trial (Promise-EBF), aimed at promoting exclusive infant feeding in three sites in South Africa. The costs were considered from the perspective of health service providers. Peer supporters in this trial visited women to support exclusive infant feeding, once antenatally and four times postpartum. Results The total economic cost of the Promise-EBF intervention was US$393 656, with average costs per woman and per visit of US$228 and US$52, respectively. The average costs per woman and visit in an operational ‘non research’ scenario were US$137 and US$32 per woman and visit, respectively. Investing in the promotion of exclusive infant feeding requires substantial financial commitment from policy makers. Extending the tasks of multi-skilled community health workers (CHWs) to include promoting exclusive infant feeding is a potential option for reducing these costs. In order to avoid efficiency losses, we recommend that the time requirements for delivering the promotion of exclusive infant feeding are considered when integrating it within the existing activities of CHWs. Discussion This paper focuses on interventions for exclusive infant feeding, but its findings more generally illustrate the importance of documenting and quantifying factors that affect the feasibility and sustainability of community-based interventions, which are receiving increased focus in low income settings. PMID:24427264

Modeling the nitrogen cycle one gene at a time

NASA Astrophysics Data System (ADS)

Coles, V.; Stukel, M. R.; Hood, R. R.; Moran, M. A.; Paul, J. H.; Satinsky, B.; Zielinski, B.; Yager, P. L.

2016-02-01

Marine ecosystem models are lagging the revolution in microbial oceanography. As a result, modeling of the nitrogen cycle has largely failed to leverage new genomic information on nitrogen cycling pathways and the organisms that mediate them. We developed a nitrogen based ecosystem model whose community is determined by randomly assigning functional genes to build each organism's "DNA". Microbes are assigned a size that sets their baseline environmental responses using allometric response curves. These responses are modified by the costs and benefits conferred by each gene in an organism's genome. The microbes are embedded in a general circulation model where environmental conditions shape the emergent population. This model is used to explore whether organisms constructed from randomized combinations of metabolic capability alone can self-organize to create realistic oceanic biogeochemical gradients. Community size spectra and chlorophyll-a concentrations emerge in the model with reasonable fidelity to observations. The model is run repeatedly with randomly-generated microbial communities and each time realistic gradients in community size spectra, chlorophyll-a, and forms of nitrogen develop. This supports the hypothesis that the metabolic potential of a community rather than the realized species composition is the primary factor setting vertical and horizontal environmental gradients. Vertical distributions of nitrogen and transcripts for genes involved in nitrification are broadly consistent with observations. Modeled gene and transcript abundance for nitrogen cycling and processing of land-derived organic material match observations along the extreme gradients in the Amazon River plume, and they help to explain the factors controlling observed variability.

Supporting the growth of peer-professional workforces in healthcare settings: an evaluation of a targeted training approach for volunteer leaders of the STEPS Program.

PubMed

Turner, Benjamin; Kennedy, Areti; Kendall, Melissa; Muenchberger, Heidi

2014-01-01

To examine the effectiveness of a targeted training approach to foster and support a peer-professional workforce in the delivery of a community rehabilitation program for adults with acquired brain injury (ABI) and their families. A prospective longitudinal design was used to evaluate the effectiveness of a targeted two-day training forum for peer (n = 25) and professional (n = 15) leaders of the Skills to Enable People and Communities Program. Leaders completed a set of questionnaires (General Self-Efficacy Scale - GSES, Rosenberg Self-Esteem Scale, Volunteer Motivation Inventory - VMI and Community Involvement Scale - CIS) both prior to and immediately following the forum. Data analysis entailed paired sample t-test to explore changes in scores over time, and independent sample t-tests for comparisons between the two participant groups. The results indicated a significant increase in scores over time for the GSES (p = 0.047). Improvements in leaders' volunteer motivations and community involvement were also observed between the two time intervals. The between group comparisons highlighted that the peer leader group scored significantly higher than the professional leader group on the CIS and several domains of the VMI at both time intervals. The study provides an enhanced understanding of the utility of innovative workforce solutions for community rehabilitation after ABI; and further highlights the benefits of targeted training approaches to support the development of such workforce configurations.

Estimation of cocaine consumption in the community: a critical comparison of the results from three complimentary techniques

PubMed Central

Reid, Malcolm J; Langford, Katherine H; Grung, Merete; Gjerde, Hallvard; Amundsen, Ellen J; Morland, Jorg; Thomas, Kevin V

2012-01-01

Objectives A range of approaches are now available to estimate the level of drug use in the community so it is desirable to critically compare results from the differing techniques. This paper presents a comparison of the results from three methods for estimating the level of cocaine use in the general population. Design The comparison applies to; a set of regional-scale sample survey questionnaires, a representative sample survey on drug use among drivers and an analysis of the quantity of cocaine-related metabolites in sewage. Setting 14 438 participants provided data for the set of regional-scale sample survey questionnaires; 2341 drivers provided oral-fluid samples and untreated sewage from 570 000 people was analysed for biomarkers of cocaine use. All data were collected in Oslo, Norway. Results 0.70 (0.36–1.03) % of drivers tested positive for cocaine use which suggest a prevalence that is higher than the 0.22 (0.13–0.30) % (per day) figure derived from regional-scale survey questionnaires, but the degree to which cocaine consumption in the driver population follows the general population is an unanswered question. Despite the comparatively low-prevalence figure the survey questionnaires did provide estimates of the volume of consumption that are comparable with the amount of cocaine-related metabolites in sewage. Per-user consumption estimates are however highlighted as a significant source of uncertainty as little or no data on the quantities consumed by individuals are available, and much of the existing data are contradictory. Conclusions The comparison carried out in the present study can provide an excellent means of checking the quality and accuracy of the three measurement techniques because they each approach the problem from a different viewpoint. Together the three complimentary techniques provide a well-balanced assessment of the drug-use situation in a given community and identify areas where more research is needed. PMID:23144259

"Communities" in community engagement: lessons learned from autism research in South Korea and South Africa.

PubMed

Grinker, Roy Richard; Chambers, Nola; Njongwe, Nono; Lagman, Adrienne E; Guthrie, Whitney; Stronach, Sheri; Richard, Bonnie O; Kauchali, Shuaib; Killian, Beverley; Chhagan, Meera; Yucel, Fikri; Kudumu, Mwenda; Barker-Cummings, Christie; Grether, Judith; Wetherby, Amy M

2012-06-01

Little research has been conducted on behavioral characteristics of children with autism spectrum disorder (ASD) from diverse cultures within the US, or from countries outside of the US or Europe, with little reliable information yet reported from developing countries. We describe the process used to engage diverse communities in ASD research in two community-based research projects-an epidemiologic investigation of 7- to 12-year olds in South Korea and the Early Autism Project, an ASD detection program for 18- to 36-month-old Zulu-speaking children in South Africa. Despite the differences in wealth between these communities, ASD is underdiagnosed in both settings, and generally not reported in clinical or educational records. Moreover, in both countries, there is low availability of services. In both cases, local knowledge helped researchers to address both ethnographic as well as practical problems. Researchers identified the ways in which these communities generate and negotiate the cultural meanings of developmental disorders. Researchers incorporated that knowledge, as they engaged communities in a research protocol, adapted and translated screening and diagnostic tools, and developed methods for screening, evaluating, and diagnosing children with ASD. © 2012 International Society for Autism Research, Wiley Periodicals, Inc.

Impact of an interprofessional rural health care practice education experience on students and communities.

PubMed

Charles, Grant; Bainbridge, Lesley; Copeman-Stewart, Kathy; Kassam, Rosemin; Tiffin, Shelly

2008-01-01

The Interprofessional Rural Program of British Columbia (IRPBC) was established in 2003 as a pilot program aimed at supporting the recruitment of health and human service professionals to rural communities in British Columbia, Canada. The program was designed to expose students in the health and human service professions to rural communities and to assess whether this exposure increased the likelihood of their return to work in nonurban settings once they completed their studies. The initial qualitative evaluation of IRPBC was conducted via individual interviews in the first year and written questionnaires in the second year. In general, IRPBC was perceived by the participants to have had a significant impact on the students and communities. The students who participated in it benefited not only from the chance to engage in rural practice but also from the opportunity to interact within an interprofessional context; and the communities participating in the program profited from enhanced health care and the possibility of attracting new practitioners from these students. Exposure to new ways of providing service and the impact that the introduction of teams of passionate students can have on both practitioners and small communities have greatly enriched the broader communities.

Community-based dental education and the importance of faculty development.

PubMed

McAndrew, Maureen

2010-09-01

Community-based dental education offers a variety of positive learning experiences for students while providing needed dental services for the underserved. More dental students are being instructed by a growing body of largely volunteer community-based faculty who practice in a wide range of community settings including community hospitals and clinics, nursing homes, and private practices. These geographically dispersed instructors may have little experience as educators. Their practice styles and their motivation to improve teaching effectiveness are likely to differ from the styles and motivation of school-based faculty members. Moreover, many dental schools have begun to emphasize practices that may be unfamiliar to community-based faculty such as evidence-based practice. Providing faculty development for them is challenging, yet crucial to the success of these programs and dental education in general. Fundamental elements that must be considered for effective community faculty development programming include fostering a culture of respect between school-based and community faculty members, basing programs on the actual needs of these educators, integrating principles of adult learning theory, and establishing ongoing institutional support. This article provides background on this movement, reviews the literature for faculty development programs geared specifically to community-based educators, makes recommendations for development programs for these dental educators, and includes suggestions for future research.

25 CFR 41.11 - General provisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION GRANTS TO TRIBALLY CONTROLLED COMMUNITY COLLEGES AND NAVAJO COMMUNITY COLLEGE Tribally Controlled Community Colleges § 41.11 General provisions. The general... to Community Colleges: (a) Services or assistance provided to Indians by Community Colleges aided...

Returns on equity for not-for-profit hospitals.

PubMed

Pauly, M V

1986-04-01

This study examines the circumstances in which a large third-party payer or regulator might want to set hospital prices to yield a positive rate of return on equity capital. The level of return is shown to depend on the willingness of donors to make funds available in the community relative to the (derived) demand for capital to produce output. It is shown that the appropriate price might well be set to yield a zero or below-market return, and that the return to not-for-profit firms should generally be less than that to for-profit firms, if for-profit firms are to be active in the market.

Returns on equity for not-for-profit hospitals.

PubMed Central

Pauly, M V

1986-01-01

This study examines the circumstances in which a large third-party payer or regulator might want to set hospital prices to yield a positive rate of return on equity capital. The level of return is shown to depend on the willingness of donors to make funds available in the community relative to the (derived) demand for capital to produce output. It is shown that the appropriate price might well be set to yield a zero or below-market return, and that the return to not-for-profit firms should generally be less than that to for-profit firms, if for-profit firms are to be active in the market. PMID:3086256

Communication strategies and volunteer management for the IAU-OAD

NASA Astrophysics Data System (ADS)

Sankatsing Nava, Tibisay

2015-08-01

The IAU Office of Astronomy for Development will be developing a new communication strategy to promote its projects in a way that is relevant to stakeholders and the general public. Ideas include a magazine featuring best practices within the field of astronomy for development and setting up a workflow of communication that integrates the different outputs of the office and effectively uses the information collection tools developed by OAD team members.To accomplish these tasks the OAD will also develop a community management strategy with existing tools to effectively harness the skills of OAD volunteers for communication purposes. This talk will discuss the new communication strategy of the OAD as well the expanded community management plans.

Environmental filtering drives the shape and breadth of the seed germination niche in coastal plant communities

PubMed Central

Pérez-Arcoiza, Adrián; Prieto, José Alberto; Díaz, Tomás E.

2017-01-01

Abstract Background and Aims A phylogenetic comparative analysis of the seed germination niche was conducted in coastal plant communities of western Europe. Two hypotheses were tested, that (1) the germination niche shape (i.e. the preference for a set of germination cues as opposed to another) would differ between beaches and cliffs to prevent seedling emergence in the less favourable season (winter and summer, respectively); and (2) the germination niche breadth (i.e. the amplitude of germination cues) would be narrower in the seawards communities, where environmental filtering is stronger. Methods Seeds of 30 specialist species of coastal plant communities were collected in natural populations of northern Spain. Their germination was measured in six laboratory treatments based on field temperatures. Germination niche shape was estimated as the best germination temperature. Germination niche breadth was calculated using Pielou’s evenness index. Differences between plant communities in their germination niche shape and breadth were tested using phylogenetic generalized least squares regression (PGLS). Key Results Germination niche shape differed between communities, being warm-cued in beaches (best germination temperature = 20 °C) and cold-cued in cliffs (14 °C). Germination niche was narrowest in seawards beaches (Pielou’s index = 0·89) and broadest in landwards beaches (0·99). Cliffs had an intermediate germination niche breadth (0·95). The relationship between niche and plant community had a positive phylogenetic signal for shape (Pagel’s λ = 0·64) and a negative one for breadth (Pagel’s λ = −1·71). Conclusion Environmental filters shape the germination niche to prevent emergence in the season of highest threat for seedling establishment. The germination niche breadth is narrower in the communities with stronger environmental filters, but only in beaches. This study provides empirical support to a community-level generalization of the hypotheses about the environmental drivers of the germination niche. It highlights the role of germination traits in community assembly. PMID:28334139

Two Methods for Engaging with the Community in Setting Priorities for Child Health Research: Who Engages?

PubMed Central

McKenzie, Anne; Hancock, Kirsten; Haines, Hayley; Christensen, Daniel; Zubrick, Stephen R.

2015-01-01

Objective The aims of this study were to assess participatory methods for obtaining community views on child health research. Background Community participation in research is recognised as an important part of the research process; however, there has been inconsistency in its implementation and application in Australia. The Western Australian Telethon Kids Institute Participation Program employs a range of methods for fostering active involvement of community members in its research. These include public discussion forums, called Community Conversations. While participation levels are good, the attendees represent only a sub-section of the Western Australian population. Therefore, we conducted a telephone survey of randomly selected households to evaluate its effectiveness in eliciting views from a broader cross-section of the community about our research agenda and community participation in research, and whether the participants would be representative of the general population. We also conducted two Conversations, comparing the survey as a recruitment tool and normal methods using the Participation Program. Results While the telephone survey was a good method for eliciting community views about research, there were marked differences in the profile of study participants compared to the general population (e.g. 78% vs 50% females). With a 26% response rate, the telephone survey was also more expensive than a Community Conversation. The cold calling approach proved an unsuccessful recruitment method, with only two out of a possible 816 telephone respondents attending a Conversation. Conclusion While the results showed that both of the methods produced useful input for our research program, we could not conclude that either method gained input that was representative of the entire community. The Conversations were relatively low-cost and provided more in-depth information about one subject, whereas the telephone survey provided information across a greater range of subjects, and allowed more quantitative analysis. PMID:25938240

Systems development and difficulties in implementing procedures for elder abuse prevention among private community general support centers in Japan.

PubMed

Nakanishi, Miharu; Nakashima, Taeko; Yamaoka, Yukako; Hada, Keiko; Tanaka, Hideaki

2014-01-01

The present study examines differences in systems development and difficulties in implementing procedures for elder abuse prevention in 1,119 private and 606 public community general support centers under the public long-term care insurance program in Japan. The private community general support centers showed more difficulty implementing procedures than the public community general support centers. Controlling for the type of municipality, progress in systems development did not differ between the private and public community general support centers. Further research should examine how the characteristics of municipal governments are related to systems development in community general support centers.

Access to HIV treatment and care for people who inject drugs in Kenya: a short report.

PubMed

Guise, Andy; Rhodes, Tim; Ndimbii, James; Ayon, Sylvia; Nnaji, Obiora

2016-12-01

People who inject drugs (PWID) experience a range of barriers to HIV treatment and care access. The Kenyan government and community-based organisations have sought to develop HIV care for PWID. A principal approach to delivery in Kenya is to provide care from clinics serving the general population and for this to be linked to support from community-based organisations providing harm reduction outreach. This study explores accounts of PWID accessing care in Kenya to identify care barriers and facilitators. PWID accounts were collected within a qualitative longitudinal study. In-depth interviews with PWID living with HIV (n = 44) are combined with interviews with other PWID, care providers and community observation. Results show that some PWID are able to access care successfully, whilst other PWID report challenges. The results focus on three principal themes to give insights into these experiences: the hardship of addiction and the costs of care, the silencing of HIV in the community and then discrimination and support in the clinic. Some PWID are able to overcome, often with social and outreach support, barriers to clinic access; for others, the challenges of addiction, hardship, stigma and discrimination are too constraining. We discuss how clinics serving the general population could be further adapted to increase access. Clinic-based care, even with community links, may, however, be fundamentally challenging for some PWID to access. Additional strategies to develop stand-alone care for PWID and also decentralise HIV treatment and care to community settings and involve peers in delivery should be considered.

An overview of the “Positive Action for Today's Health” (PATH) trial for increasing walking in low income, ethnic minority communities

PubMed Central

Wilson, Dawn K.; Trumpeter, Nevelyn N.; St. George, Sara M.; Coulon, Sandra M.; Griffin, Sarah; Van Horn, M. Lee; Lawman, Hannah G.; Wandersman, Abe; Egan, Brent; Forthofer, Melinda; Goodlett, Benjamin D.; Kitzman-Ulrich, Heather; Gadson, Barney

2012-01-01

Background Ethnic minorities and lower-income adults have among the highest rates of obesity and lowest levels of regular physical activity (PA). The Positive Action for Today's Health (PATH) trial compares three communities that are randomly assigned to different levels of an environmental intervention to improve safety and access for walking in low income communities. Design and setting Three communities matched on census tract information (crime, PA, ethnic minorities, and income) were randomized to receive either: an intervention that combines a police-patrolled-walking program with social marketing strategies to promote PA, a police-patrolled-walking only intervention, or no-walking intervention (general health education only). Measures include PA (7-day accelerometer estimates), body composition, blood pressure, psychosocial measures, and perceptions of safety and access for PA at baseline, 6, 12, 18, and 24 months. Intervention The police-patrolled walking plus social marketing intervention targets increasing safety (training community leaders as walking captains, hiring off-duty police officers to patrol the walking trail, and containing stray dogs), increasing access for PA (marking a walking route), and utilizes a social marketing campaign that targets psychosocial and environmental mediators for increasing PA. Main hypotheses/outcomes It is hypothesized that the police-patrolled walking plus social marketing intervention will result in greater increases in moderate-to-vigorous PA as compared to the police-patrolled-walking only or the general health intervention after 12 months and that this effect will be maintained at 18 and 24 months. Conclusions Implications of this community-based trial are discussed. PMID:20801233

Power law analysis of the human microbiome.

PubMed

Ma, Zhanshan Sam

2015-11-01

Taylor's (1961, Nature, 189:732) power law, a power function (V = am(b) ) describing the scaling relationship between the mean and variance of population abundances of organisms, has been found to govern the population abundance distributions of single species in both space and time in macroecology. It is regarded as one of few generalities in ecology, and its parameter b has been widely applied to characterize spatial aggregation (i.e. heterogeneity) and temporal stability of single-species populations. Here, we test its applicability to bacterial populations in the human microbiome using extensive data sets generated by the US-NIH Human Microbiome Project (HMP). We further propose extending Taylor's power law from the population to the community level, and accordingly introduce four types of power-law extensions (PLEs): type I PLE for community spatial aggregation (heterogeneity), type II PLE for community temporal aggregation (stability), type III PLE for mixed-species population spatial aggregation (heterogeneity) and type IV PLE for mixed-species population temporal aggregation (stability). Our results show that fittings to the four PLEs with HMP data were statistically extremely significant and their parameters are ecologically sound, hence confirming the validity of the power law at both the population and community levels. These findings not only provide a powerful tool to characterize the aggregations of population and community in both time and space, offering important insights into community heterogeneity in space and/or stability in time, but also underscore the three general properties of power laws (scale invariance, no average and universality) and their specific manifestations in our four PLEs. © 2015 John Wiley & Sons Ltd.

A Systematic Evaluation of Field-Based Screening Methods for the Assessment of Anterior Cruciate Ligament (ACL) Injury Risk.

PubMed

Fox, Aaron S; Bonacci, Jason; McLean, Scott G; Spittle, Michael; Saunders, Natalie

2016-05-01

Laboratory-based measures provide an accurate method to identify risk factors for anterior cruciate ligament (ACL) injury; however, these methods are generally prohibitive to the wider community. Screening methods that can be completed in a field or clinical setting may be more applicable for wider community use. Examination of field-based screening methods for ACL injury risk can aid in identifying the most applicable method(s) for use in these settings. The objective of this systematic review was to evaluate and compare field-based screening methods for ACL injury risk to determine their efficacy of use in wider community settings. An electronic database search was conducted on the SPORTDiscus™, MEDLINE, AMED and CINAHL databases (January 1990-July 2015) using a combination of relevant keywords. A secondary search of the same databases, using relevant keywords from identified screening methods, was also undertaken. Studies identified as potentially relevant were independently examined by two reviewers for inclusion. Where consensus could not be reached, a third reviewer was consulted. Original research articles that examined screening methods for ACL injury risk that could be undertaken outside of a laboratory setting were included for review. Two reviewers independently assessed the quality of included studies. Included studies were categorized according to the screening method they examined. A description of each screening method, and data pertaining to the ability to prospectively identify ACL injuries, validity and reliability, recommendations for identifying 'at-risk' athletes, equipment and training required to complete screening, time taken to screen athletes, and applicability of the screening method across sports and athletes were extracted from relevant studies. Of 1077 citations from the initial search, a total of 25 articles were identified as potentially relevant, with 12 meeting all inclusion/exclusion criteria. From the secondary search, eight further studies met all criteria, resulting in 20 studies being included for review. Five ACL-screening methods-the Landing Error Scoring System (LESS), Clinic-Based Algorithm, Observational Screening of Dynamic Knee Valgus (OSDKV), 2D-Cam Method, and Tuck Jump Assessment-were identified. There was limited evidence supporting the use of field-based screening methods in predicting ACL injuries across a range of populations. Differences relating to the equipment and time required to complete screening methods were identified. Only screening methods for ACL injury risk were included for review. Field-based screening methods developed for lower-limb injury risk in general may also incorporate, and be useful in, screening for ACL injury risk. Limited studies were available relating to the OSDKV and 2D-Cam Method. The LESS showed predictive validity in identifying ACL injuries, however only in a youth athlete population. The LESS also appears practical for community-wide use due to the minimal equipment and set-up/analysis time required. The Clinic-Based Algorithm may have predictive value for ACL injury risk as it identifies athletes who exhibit high frontal plane knee loads during a landing task, but requires extensive additional equipment and time, which may limit its application to wider community settings.

Generating perfect fluid spheres in general relativity

NASA Astrophysics Data System (ADS)

Boonserm, Petarpa; Visser, Matt; Weinfurtner, Silke

2005-06-01

Ever since Karl Schwarzschild’s 1916 discovery of the spacetime geometry describing the interior of a particular idealized general relativistic star—a static spherically symmetric blob of fluid with position-independent density—the general relativity community has continued to devote considerable time and energy to understanding the general-relativistic static perfect fluid sphere. Over the last 90 years a tangle of specific perfect fluid spheres has been discovered, with most of these specific examples seemingly independent from each other. To bring some order to this collection, in this article we develop several new transformation theorems that map perfect fluid spheres into perfect fluid spheres. These transformation theorems sometimes lead to unexpected connections between previously known perfect fluid spheres, sometimes lead to new previously unknown perfect fluid spheres, and in general can be used to develop a systematic way of classifying the set of all perfect fluid spheres.

Improving the self-efficacy of teachers in schools: results of health promotion program.

PubMed

Farokhzadian, Jamileh; Sabzi, Amirreza; Mangolian Shahrbabaki, Parvin

2018-06-12

Background In order to effectively facilitate behavior change, it is essential to conduct health promotion programs on self-efficacy. Given the importance of the role of teachers in fostering the next generation, it appears that the promotion of self-efficacy in them can greatly contribute to the health of the community. The present study aimed to evaluate the impact of a health promotion training workshop on self-efficacy for health practices and also, on general self-efficacy of teachers in schools. Methods This study was a quasi-experimental study, in which 120 teachers were selected by random sampling and randomly divided into two equal intervention and control groups (60 in each group). A health promotion training workshop was conducted for the intervention group. Data were collected by a three-section questionnaire (demographic, self-rated ability for health practices scale and general self-efficacy) before and 1 month after the training intervention. Results The self-efficacy scores for health practices and general self-efficacy were not significantly different between the intervention and control groups before the intervention (p > 0.05). However, participants in the intervention group reported higher scores on both the self-efficacy for health practices (t = 4.05, p = 0.001) and general self-efficacy (t = 2.92, p = 0.004) compared to those in the control group one month after the intervention. Conclusion The health promotion training program had improving effects on the self-efficacy for health practices and general self-efficacy. This program was potentially a valid community health nursing intervention that can be presented and evaluated in various community settings.

Community service provider perceptions of implementing older adult fall prevention in Ontario, Canada: a qualitative study.

PubMed

Dykeman, Catherine S; Markle-Reid, Maureen F; Boratto, Lorna J; Bowes, Chris; Gagné, Hélène; McGugan, Jennifer L; Orr-Shaw, Sarah

2018-02-01

Despite evidence for effective fall prevention interventions, measurable reductions in older adult (≥ 65 years) fall rates remain unrealized. This study aimed to describe the perceived barriers to and effective strategies for the implementation of evidence-based fall prevention practices within and across diverse community organizations. This study is unique in that it included community service providers who are not generally thought to provide fall prevention services to older adults, such as retail business, community support, volunteer services, community foundations, recreation centres, and various emergency services. Interviews and focus groups were conducted with a purposive sampling of providers (n = 84) in varied roles within diverse community-based organizations across disparate geographical settings. Community service providers experience significant multi-level barriers to fall prevention within and across organizations and settings. The overall challenge of serving dispersed populations in adverse environmental conditions was heightened in northern rural areas. Barriers across the system, within organizations and among providers themselves emerged along themes of Limited Coordination of Communication, Restrictive Organizational Mandates and Policies, Insufficient Resources, and Beliefs about Aging and Falls. Participants perceived that Educating Providers, Working Together, and Changing Policies and Legislation were strategies that have worked or would work well in implementing fall prevention. An unintentional observation was made that several participants in this extremely varied sample identified expanded roles in fall prevention for themselves during the interview process. Community service providers experience disabling contexts for implementing fall prevention on many levels: their specific geography, their service systems, their organizations and themselves. A systemic lack of fit between the older adult and fall prevention services limits access, making fall prevention inaccessible, unaccommodating, unavailable, unaffordable, and unacceptable. Educating Providers, Working Together, and Changing Policies and Legislation offers promise to create more enabling contexts for community stakeholders, including those who do not initially see their work as preventing falls.

Performance factors of mobile rich media job aids for community health workers

PubMed Central

Florez-Arango, Jose F; Dunn, Kim; Zhang, Jiajie

2011-01-01

Objective To study and analyze the possible benefits on performance of community health workers using point-of-care clinical guidelines implemented as interactive rich media job aids on small-format mobile platforms. Design A crossover study with one intervention (rich media job aids) and one control (traditional job aids), two periods, with 50 community health workers, each subject solving a total 15 standardized cases per period per period (30 cases in total per subject). Measurements Error rate per case and task, protocol compliance. Results A total of 1394 cases were evaluated. Intervention reduces errors by an average of 33.15% (p=0.001) and increases protocol compliance 30.18% (p<0.001). Limitations Medical cases were presented on human patient simulators in a laboratory setting, not on real patients. Conclusion These results indicate encouraging prospects for mHealth technologies in general, and the use of rich media clinical guidelines on cell phones in particular, for the improvement of community health worker performance in developing countries. PMID:21292702

Performance factors of mobile rich media job aids for community health workers.

PubMed

Florez-Arango, Jose F; Iyengar, M Sriram; Dunn, Kim; Zhang, Jiajie

2011-01-01

To study and analyze the possible benefits on performance of community health workers using point-of-care clinical guidelines implemented as interactive rich media job aids on small-format mobile platforms. A crossover study with one intervention (rich media job aids) and one control (traditional job aids), two periods, with 50 community health workers, each subject solving a total 15 standardized cases per period per period (30 cases in total per subject). Error rate per case and task, protocol compliance. A total of 1394 cases were evaluated. Intervention reduces errors by an average of 33.15% (p = 0.001) and increases protocol compliance 30.18% (p < 0.001). Limitations Medical cases were presented on human patient simulators in a laboratory setting, not on real patients. These results indicate encouraging prospects for mHealth technologies in general, and the use of rich media clinical guidelines on cell phones in particular, for the improvement of community health worker performance in developing countries.

Setting Up a Mental Health Clinic in the Heart of Rural Africa.

PubMed

Enow, Humphrey; Thalitaya, Madhusudan Deepak; Mbatia, Wallace; Kirpekar, Sheetal

2015-09-01

The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO 1948). In Africa, mental health issues often come last on the list of priorities for policy-makers & people's attitudes towards mental illness are strongly influenced by traditional beliefs in supernatural causes/remedies. The massive burden attributed to mental illness in these communities, poses a huge moral, cultural/economic challenge and requires a concerted and integrated approach involving policy makers, mental health Practitioners, the general public, service users and their families and other stake holders to reverse the trend. Improving community awareness of mental illness. Change the negative perception of mental illness by the community. Providing a screening/referral pathway for mental illnesses. Providing supervision of patient care. Promote community participation on issues regarding mental health with a view to challenge existing traditional attitudes and beliefs, reduce stigma and promote health seeking behaviour.

Segmenting a general practitioner market to improve recruitment outcomes.

PubMed

Hemphill, Elizabeth; Kulik, Carol T

2011-05-01

Recruitment is an ongoing challenge in the health industry with general practitioner (GP) shortages in many areas beyond rural and Indigenous communities. This paper suggests a marketing solution that identifies different segments of the GP market for recruitment strategy development. In February 2008, 96 GPs in Australia responded to a mail questionnaire (of which 85 questionnaires were useable). A total of 350 GPs were sent the questionnaire. Respondents considered small sets of attributes in the decision to accept a new job at a general practice and selected the most and least important attribute from each set. We identified latent class clusters (cohorts) of GPs from the most-least important data. Three cohorts were found in the GP market, distinguishing practitioners who emphasised job, family or practice attributes in their decision to join a practice. Few significant demographic differences exist between the cohorts. A segmented GP market suggests two alternative recruitment strategies. One option is for general practices to target members of a single cohort (family-, job-, or practice-focussed GPs). The other option is for general practices to diversify their recruitment strategies to target all three cohorts (family-, job- and practice-focussed GPs). A single brand (practice) can have multiple advertising strategies with each strategy involving advertising activities targeting a particular consumer segment.

A cross sectional study of surgical training among United Kingdom general practitioners with specialist interests in surgery.

PubMed

Ferguson, H J M; Fitzgerald, J E F; Reilly, J; Beamish, A J; Gokani, V J

2015-04-08

Increasing numbers of minor surgical procedures are being performed in the community. In the UK, general practitioners (family medicine physicians) with a specialist interest (GPwSI) in surgery frequently undertake them. This shift has caused decreases in available cases for junior surgeons to gain and consolidate operative skills. This study evaluated GPwSI's case-load, procedural training and perceptions of offering formalised operative training experience to surgical trainees. Prospective, questionnaire-based cross-sectional study. A novel, 13-item, self-administered questionnaire was distributed to members of the Association of Surgeons in Primary Care (ASPC). A total 113 of 120 ASPC members completed the questionnaire, representing a 94% response rate. Respondents were general practitioners practising or intending to practice surgery in the community. Respondents performed a mean of 38 (range 5-150) surgical procedures per month in primary care. 37% (42/113) of respondents had previously been awarded Membership or Fellowship of a Surgical Royal College; 22% (25/113) had completed a surgical certificate or diploma or undertaken a course of less than 1 year duration. 41% (46/113) had no formal British surgical qualifications. All respondents believed that surgical training in primary care could be valuable for surgical trainees, and the majority (71/113, 63%) felt that both general practice and surgical trainees could benefit equally from such training. There is a significant volume of surgical procedures being undertaken in the community by general practitioners, with the capacity and appetite for training of prospective surgeons in this setting, providing appropriate standards are achieved and maintained, commensurate with current standards in secondary care. Surgical experience and training of GPwSI's in surgery is highly varied, and does not yet benefit from the quality assurance secondary care surgical training in the UK undergoes. The Royal Colleges of Surgery and General Practice are well placed to invest in such infrastructure to provide long-term, high-quality service and training in the community. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

New Zealand rural primary health care workforce in 2005: more than just a doctor shortage.

PubMed

Goodyear-Smith, Felicity; Janes, Ron

2008-02-01

To obtain a 2005 snapshot of New Zealand (NZ) rural primary health care workforce, specifically GPs, general practice nurses and community pharmacists. Postal questionnaires, November 2005. NZ-wide rural general practices and community pharmacies. Rural general practice managers, GPs, nurses, community pharmacy managers and pharmacists. Self-reported data: demographics, country of training, years in practice, business ownership, hours worked including on-call, intention to leave rural practice. General practices: response rate 95% (206/217); 70% GP-owned, practice size ranged from one GP/one nurse to 12 GPs/nine nurses. PHARMACIES: Response rate 90% (147/163). Majority had one (33%) or two (32%) pharmacists; <10% had more than three pharmacists. GPs: response rate 64% (358/559), 71% male, 73% aged >40, 61% full-time, 79% provide on-call, 57% overseas-trained, 78% male and 57% female GPs aged >40; more full-time male GPs (76%) than female (37%) . Nurses: response rate 65% (445/685), 97% female, 72% aged >40, 31% full-time, 28% provide on-call, 84% NZ-trained, 45% consulted independently in 'nurse-clinics' within practice setting. Pharmacists: response rate 96% (248/258), 52% male, 66% aged >40, 71% full-time, 33% provide on-call, 92% NZ-trained, 55% sole/partner pharmacy owners. Many intend to leave NZ rural practice within 5 years: GPs (34%), nurses (25%) and pharmacists (47%). This is the first NZ-wide rural workforce survey to include a range of rural primary health care providers (GPs, nurses and pharmacists). Ageing rural primary health care workforce and intentions to leave herald worsening workforce shortages.

Evolution properties of the community members for dynamic networks

NASA Astrophysics Data System (ADS)

Yang, Kai; Guo, Qiang; Li, Sheng-Nan; Han, Jing-Ti; Liu, Jian-Guo

2017-03-01

The collective behaviors of community members for dynamic social networks are significant for understanding evolution features of communities. In this Letter, we empirically investigate the evolution properties of the new community members for dynamic networks. Firstly, we separate data sets into different slices, and analyze the statistical properties of new members as well as communities they joined in for these data sets. Then we introduce a parameter φ to describe community evolution between different slices and investigate the dynamic community properties of the new community members. The empirical analyses for the Facebook, APS, Enron and Wiki data sets indicate that both the number of new members and joint communities increase, the ratio declines rapidly and then becomes stable over time, and most of the new members will join in the small size communities that is s ≤ 10. Furthermore, the proportion of new members in existed communities decreases firstly and then becomes stable and relatively small for these data sets. Our work may be helpful for deeply understanding the evolution properties of community members for social networks.

[General aspects of planning and care in mental health].

PubMed

Saforcada, E

1976-09-01

This paper reviews some general concepts on Planning, especially in public and welfare sectors, stressing those concerning the major flaws in the argentine system of mental health. The author considers the definition of planning levels, and sets forth three: general plan, program and project. The correlative implementation is also considered. The importance of feed-back from adequate evaluation is stressed, emphasizing three aspects: a) evaluation of dynamics, rate and extent of decrease, increase or stagnation; b) assessment of efficacity of factors involved; c) control and stabilization of goals already attained. The necessity to develop a human ecology, encompassing socio-cultural and psycho-social factors is stressed, together with fostering theoretical research and the use of its results by implementation agents. Several differences among prevailing mental health actions are pointed out which allow a distinction between two typical models: clinical and sanitarist. The main differences between them lye on: standard location of working sites, nature of basic actions, field of action, hypothesis for working, including ethiological and ecological assumptions, theoretical and methodological framework. A series of criteria for evaluating sanitary techniques and strategies are set forth, among which: operative procedures, length of treatments, degree of therapeutic concentration, and general pragmatic criteria. The indicators reviewed are: degree of efficacity, covering, degree of perseverance in treatments, cultural barriers between patient and therapist, delegation of functions into special, first-rate sanitary agents, needs for the training of mental health workers. An attempt is made at developping general evaluation criteria for mental health planning, and several indicators are proposed, among which: a) cost/efficacity ratio, including in costs the use of economical, human and physical resources; b) preventive capacities of the community; c) capacities for the community to generate new types of organization and social dynamics able to cope with increasing mental health demands; first-rate personnel and mental health agents performance and training; e) assessment of "distances" between theoretical planning and actual implementation outlines; f) requirements of time for the implementation of programs.

Data sets for author name disambiguation: an empirical analysis and a new resource.

PubMed

Müller, Mark-Christoph; Reitz, Florian; Roy, Nicolas

2017-01-01

Data sets of publication meta data with manually disambiguated author names play an important role in current author name disambiguation (AND) research. We review the most important data sets used so far, and compare their respective advantages and shortcomings. From the results of this review, we derive a set of general requirements to future AND data sets. These include both trivial requirements, like absence of errors and preservation of author order, and more substantial ones, like full disambiguation and adequate representation of publications with a small number of authors and highly variable author names. On the basis of these requirements, we create and make publicly available a new AND data set, SCAD-zbMATH. Both the quantitative analysis of this data set and the results of our initial AND experiments with a naive baseline algorithm show the SCAD-zbMATH data set to be considerably different from existing ones. We consider it a useful new resource that will challenge the state of the art in AND and benefit the AND research community.

The Future of General Surgery: Evolving to Meet a Changing Practice.

PubMed

Webber, Eric M; Ronson, Ashley R; Gorman, Lisa J; Taber, Sarah A; Harris, Kenneth A

2016-01-01

Similar to other countries, the practice of General Surgery in Canada has undergone significant evolution over the past 30 years without major changes to the training model. There is growing concern that current General Surgery residency training does not provide the skills required to practice the breadth of General Surgery in all Canadian communities and practice settings. Led by a national Task Force on the Future of General Surgery, this project aimed to develop recommendations on the optimal configuration of General Surgery training in Canada. A series of 4 evidence-based sub-studies and a national survey were launched to inform these recommendations. Generalized findings from the multiple methods of the project speak to the complexity of the current practice of General Surgery: (1) General surgeons have very different practice patterns depending on the location of practice; (2) General Surgery training offers strong preparation for overall clinical competence; (3) Subspecialized training is a new reality for today's general surgeons; and (4) Generation of the report and recommendations for the future of General Surgery. A total of 4 key recommendations were developed to optimize General Surgery for the 21st century. This project demonstrated that a high variability of practice dependent on location contrasts with the principles of implementing the same objectives of training for all General Surgery graduates. The overall results of the project have prompted the Royal College to review the training requirements and consider a more "fit for purpose" training scheme, thus ensuring that General Surgery residency training programs would optimally prepare residents for a broad range of practice settings and locations across Canada. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Social Connections for Older People with Intellectual Disability in Ireland: Results from Wave One of IDS-TILDA.

PubMed

McCausland, Darren; McCallion, Philip; Cleary, Eimear; McCarron, Mary

2016-01-01

The literature on influences of community versus congregated settings raises questions about how social inclusion can be optimised for people with intellectual disability. This study examines social contacts for older people with intellectual disability in Ireland, examining differences in social connection for adults with intellectual disability and other adults. Data were drawn from the IDS-TILDA study in Ireland. A nationally representative sample (n = 753) included adults aged 40 years and older, with additional comparison with general population participants. Predictors of social contacts were explored. Residence, level of intellectual disability and age were significant factors determining social contact. People in institutional residences, older respondents and those with severe/profound intellectual disability had the lowest levels of contact; older adults with intellectual disability had much lower rates than general population counterparts. Community-dwelling people with intellectual disability have greater social contact than those living in institutions, but levels are below those for other adults in Ireland. © 2015 John Wiley & Sons Ltd.

Access to dental care-parents' and caregivers' views on dental treatment services for people with disabilities.

PubMed

Prabhu, Neeta T; Nunn, June H; Evans, D J; Girdler, N M

2010-01-01

The goal of this study was to elicit the views of patients or parents/caregivers of patients with disabilities regarding access to dental care. A questionnaire was generated both from interviews with patients/parents/caregivers already treated under sedation or general anesthesia as well as by use of the Delphi technique with other stakeholders. One hundred thirteen patients from across six community dental clinics and one dental hospital were included. Approximately, 38% of the subjects used a general dental practitioner and 35% used the community dental service for their dental care, with only 27% using the hospital dental services. Overall waiting time for an appointment at the secondary care setting was longer than for the primary care clinics. There was a high rate of parent/caregiver satisfaction with dental services and only five patients reported any difficulty with travel and access to clinics. This study highlights the need for a greater investment in education and training to improve skills in the primary dental care sector.

A Study of 279 General Outbreaks of Gastrointestinal Infection in the North-East Region of England

PubMed Central

Tebbutt, Grahame M.; Wilson, Deborah; Holtby, Ian

2009-01-01

All outbreaks of infectious intestinal disease reported to the authorities were entered on a computer database with outbreak control teams being established to investigate larger or more significant incidents. The outbreak database and, when set up, the notes of outbreak team meetings were examined for the 279 outbreaks reported in a three-year period (2003–2005). Faeces specimens submitted as part of an outbreak were examined for microbial pathogens and the results cross-matched to the outbreak number. Almost half of the general outbreaks reported (137) occurred in long-term care facilities for the elderly, 51 outbreaks were recorded in hospitals and 31 occurred in the wider community. In 76 outbreaks no specimen was logged. A microbial cause was confirmed in about one-third of outbreaks, with noroviruses being the most common (19%). Salmonellas accounted for 12 of the 21 community outbreaks linked to social events and all were foodborne. Suggestions for improving notification and surveillance are discussed. PMID:19440398

The use of oral nutritional supplements in an Irish community setting.

PubMed

Kennelly, S; Kennedy, N P; Rughoobur, G Flanagan; Slattery, C Glennon; Sugrue, S

2009-12-01

The frequency of oral nutritional supplement (ONS) prescribing has been increasing steadily in the Republic of Ireland (ROI). Available evidence indicates that health professionals in the community setting in the ROI have a poor level of knowledge about ONS. The objectives of the present study were to investigate ONS prescribing practices and to identify the types of patient who were prescribed these products. Ten of 17 eligible general practitioners were recruited and asked to refer all patients (aged > 16 years) who were prescribed ONS during a 3-month period. Patients were interviewed by a community dietitian, using a questionnaire incorporating the Malnutrition Universal Screening Tool (MUST). ONS prescriptions were judged either to fulfil or not to fulfil a set of criteria developed for ONS prescribing in the community. The majority of patients were female (62/78). Their mean (SD) age was 79 (10.5) years. According to MUST criteria, 31 of 78 patients were at 'low risk', 18 of 78 were at 'medium risk' and 29 of 78 were at 'high risk' of malnutrition. Less than half of the patients (36/78) had a body mass index of < 20 kg m(-2). Only 21 of 78 patients reported having received dietary advice in addition to their ONS prescription. Almost one-third (31%) of ONS prescriptions did not fulfil the criteria. Social factors, such as living alone, and difficulties with cooking and shopping, influenced the need for ONS in almost 70% of cases. ONS were prescribed in accordance with the prescribing criteria in the majority of cases; however, some patients who were prescribed ONS were not 'at risk' of malnutrition. Social circumstances played an important part in determining the need for ONS prescriptions.

Host plant development, water level and water parameters shape Phragmites australis-associated oomycete communities and determine reed pathogen dynamics in a large lake.

PubMed

Wielgoss, Anna; Nechwatal, Jan; Bogs, Carolin; Mendgen, Kurt

2009-08-01

In a 3-year-study, we analysed the population dynamics of the reed pathogen Pythium phragmitis and other reed-associated oomycetes colonizing fresh and dried reed leaves in the littoral zone of a large lake. Oomycete communities derived from internal transcribed spacer clone libraries were clearly differentiated according to substrate and seasonal influences. In fresh leaves, diverse communities consisting of P. phragmitis and other reed-associated pathogens were generally dominant. Pythium phragmitis populations peaked in spring with the emergence of young reed shoots, and in autumn after extreme flooding events. In summer it decreased with falling water levels, changing water chemistry and rising temperatures. Another Pythium species was also highly abundant in fresh leaves throughout the year and might represent a new, as-yet uncultured reed pathogen. In dried leaves, reed pathogens were rarely detected, whereas saprophytic species occurred abundantly during all seasons. Saprophyte communities were less diverse, less temperature sensitive and independent of reed development. In general, our results provide evidence for the occurrence of highly specialized sets of reed-associated oomycetes in a natural reed ecosystem. Quantitative analyses (clone abundances and quantitative real-time PCR) revealed that the reed pathogen P. phragmitis is particularly affected by changing water levels, water chemistry and the stage of reed development.

From cottage to community hospitals: Watlington Cottage Hospital and its regional context, 1874-2000.

PubMed

Hall, John

2012-01-01

The appearance in England from the 1850s of 'cottage hospitals' in considerable numbers constituted a new and distinctive form of hospital provision. The historiography of hospital care has emphasised the role of the large teaching hospitals, to the neglect of the smaller and general practitioner hospitals. This article inverts that attention, by examining their history and shift in function to 'community hospitals'within their regional setting in the period up to 2000. As the planning of hospitals on a regional basis began from the 1920s, the impact of NHS organisational and planning mechanisms on smaller hospitals is explored through case studies at two levels. The strategy for community hospitals of the Oxford NHS Region--one of the first Regions to formulate such a strategy--and the impact of that strategy on one hospital, Watlington Cottage Hospital, is critically examined through its existence from 1874 to 2000.

Defining effective community support for long-term psychiatric patients according to behavioural principles.

PubMed

Evans, I M; Moltzen, N L

2000-08-01

The purpose of this article is to define the characteristics of effective support in community mental health settings for patients with serious and persistent mental illness. A broad literature providing empirical evidence on competent caregiver behaviours and styles is selectively reviewed. Relevant findings from family caregiver research and studies of social environments that enhance skill development in people with intellectual disabilities are incorporated, within a cognitive-behavioural framework. Six important domains are identified which represent positive caregiver styles: acceptance, creating a positive atmosphere, expectations of change, responsiveness, normalisation and educativeness. The characteristics hypothesised to be critical for caregivers and support workers are defined in a general way that can allow for individualisation according to the goals of the programs and the cultural priorities of staff and patients. Further empirical validation of these characteristics would enable community mental health services to provide more specialised clinical treatments.

Mapping the ecological networks of microbial communities.

PubMed

Xiao, Yandong; Angulo, Marco Tulio; Friedman, Jonathan; Waldor, Matthew K; Weiss, Scott T; Liu, Yang-Yu

2017-12-11

Mapping the ecological networks of microbial communities is a necessary step toward understanding their assembly rules and predicting their temporal behavior. However, existing methods require assuming a particular population dynamics model, which is not known a priori. Moreover, those methods require fitting longitudinal abundance data, which are often not informative enough for reliable inference. To overcome these limitations, here we develop a new method based on steady-state abundance data. Our method can infer the network topology and inter-taxa interaction types without assuming any particular population dynamics model. Additionally, when the population dynamics is assumed to follow the classic Generalized Lotka-Volterra model, our method can infer the inter-taxa interaction strengths and intrinsic growth rates. We systematically validate our method using simulated data, and then apply it to four experimental data sets. Our method represents a key step towards reliable modeling of complex, real-world microbial communities, such as the human gut microbiota.

Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness.

PubMed

Mangurian, Christina; Niu, Grace C; Schillinger, Dean; Newcomer, John W; Dilley, James; Handley, Margaret A

2017-11-14

Individuals with severe mental illness (e.g., schizophrenia, bipolar disorder) die 10-25 years earlier than the general population, primarily from premature cardiovascular disease (CVD). Contributing factors are complex, but include systemic-related factors of poorly integrated primary care and mental health services. Although evidence-based models exist for integrating mental health care into primary care settings, the evidence base for integrating medical care into specialty mental health settings is limited. Such models are referred to as "reverse" integration. In this paper, we describe the application of an implementation science framework in designing a model to improve CVD outcomes for individuals with severe mental illness (SMI) who receive services in a community mental health setting. Using principles from the theory of planned behavior, focus groups were conducted to understand stakeholder perspectives of barriers to CVD risk factor screening and treatment identify potential target behaviors. We then applied results to the overarching Behavior Change Wheel framework, a systematic and theory-driven approach that incorporates the COM-B model (capability, opportunity, motivation, and behavior), to build an intervention to improve CVD risk factor screening and treatment for people with SMI. Following a stepped approach from the Behavior Change Wheel framework, a model to deliver primary preventive care for people that use community mental health settings as their de facto health home was developed. The CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness) model focuses on engaging community psychiatrists to expand their scope of practice to become responsible for CVD risk, with significant clinical decision support. The CRANIUM model was designed by integrating behavioral change theory and implementation theory. CRANIUM is feasible to implement, is highly acceptable to, and targets provider behavior change, and is replicable and efficient for helping to integrate primary preventive care services in community mental health settings. CRANIUM can be scaled up to increase CVD preventive care delivery and ultimately improve health outcomes among people with SMI served within a public mental health care system.

Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities.

PubMed

Ekberg, Joakim; Timpka, Toomas; Angbratt, Marianne; Frank, Linda; Norén, Anna-Maria; Hedin, Lena; Andersen, Emelie; Gursky, Elin A; Gäre, Boel Andersson

2013-07-04

An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities. Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified. The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions. OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users' needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.

Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013–2014

PubMed Central

Morgan, Emily H.; Connor, Leah M.; Garner, Jennifer A.; King, Abby C.; Sheats, Jylana L.; Winter, Sandra J.; Buman, Matthew P.

2015-01-01

Introduction A community’s built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement. Methods Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change. Results Twenty-four adults (mean age, 69.4 y [standard deviation, 13.2 y]), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use. Conclusion An electronic tablet–based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions. PMID:26133645

Use of mobile technology in a community mental health setting.

PubMed

Glick, Gretl; Druss, Benjamin; Pina, Jamie; Lally, Cathy; Conde, Mark

2016-10-01

mHealth holds promise in transforming care for people with serious mental illness (SMI) and other disadvantaged populations. However, information about the rates of smartphone ownership and usage of mobile health apps among people with SMI is limited. The objective of this research is to examine the current ownership, usage patterns, and existing barriers to mobile health interventions for people with SMI treated in a public sector community mental health setting and to compare the findings with national usage patterns from the general population. A survey was conducted to determine rates of ownership of smartphone devices among people with SMI. Surveys were administered to 100 patients with SMI at an outpatient psychiatric clinic. Results were compared with respondents to the 2012 Pew Survey of mobile phone usage. A total of 85% of participants reported that they owned a cell phone; of those, 37% reported that they owned a smartphone, as compared with 53% of respondents to the Pew Survey and 44% of socioeconomically disadvantaged respondents to the Pew Survey. While cell phone ownership is common among people with SMI, their adoption of smartphone technology lags behind that of the general population primarily due to cost barriers. Efforts to use mHealth in these populations need to recognize current mobile ownership patterns while planning for anticipated expansion of new technologies to poor populations as cost barriers are reduced in the coming years. © The Author(s) 2015.

25 CFR 41.27 - General provisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION GRANTS TO TRIBALLY CONTROLLED COMMUNITY COLLEGES AND NAVAJO COMMUNITY COLLEGE Navajo Community College § 41.27 General provisions. The general requirements... the Navajo Community College. (a) Services or assistance provided to Indians by the College with the...

Epidemiological and economic burden of Clostridium difficile in the United States: estimates from a modeling approach.

PubMed

Desai, Kamal; Gupta, Swati B; Dubberke, Erik R; Prabhu, Vimalanand S; Browne, Chantelle; Mast, T Christopher

2016-06-18

Despite a large increase in Clostridium difficile infection (CDI) severity, morbidity and mortality in the US since the early 2000s, CDI burden estimates have had limited generalizability and comparability due to widely varying clinical settings, populations, or study designs. A decision-analytic model incorporating key input parameters important in CDI epidemiology was developed to estimate the annual number of initial and recurrent CDI cases, attributable and all-cause deaths, economic burden in the general population, and specific number of high-risk patients in different healthcare settings and the community in the US. Economic burden was calculated adopting a societal perspective using a bottom-up approach that identified healthcare resources consumed in the management of CDI. Annually, a total of 606,058 (439,237 initial and 166,821 recurrent) episodes of CDI were predicted in 2014: 34.3 % arose from community exposure. Over 44,500 CDI-attributable deaths in 2014 were estimated to occur. High-risk susceptible individuals representing 5 % of the total hospital population accounted for 23 % of hospitalized CDI patients. The economic cost of CDI was $5.4 billion ($4.7 billion (86.7 %) in healthcare settings; $725 million (13.3 %) in the community), mostly due to hospitalization. A modeling framework provides more comprehensive and detailed national-level estimates of CDI cases, recurrences, deaths and cost in different patient groups than currently available from separate individual studies. As new treatments for CDI are developed, this model can provide reliable estimates to better focus healthcare resources to those specific age-groups, risk-groups, and care settings in the US where they are most needed. (Trial Identifier ClinicaTrials.gov: NCT01241552).

Ontario family physician readiness to collaborate with community pharmacists on drug therapy management.

PubMed

Pojskic, Nedzad; Mackeigan, Linda; Boon, Heather; Ellison, Philip; Breslin, Curtis

2011-03-01

Empirical evidence suggests that pharmacist-physician collaboration can improve patients' clinical outcomes; however, such collaboration occurs relatively infrequently in the community setting. There has been little research on physicians' perspectives of such collaboration. To ascertain Ontario family physician readiness to collaborate with community pharmacists on drug therapy management. The survey instrument was based on the transtheoretical model of behavior change. It enquired about 3 physician behaviors that represented low-, mid-, and high-level collaboration with pharmacists. The survey was distributed by fax or mail to a random sample of 848 Ontario family physicians and general practitioners, stratified by practice location (urban/rural). The response rate was 36%. Most respondents reported conversing with community pharmacists about a patient's drug therapy management 5 or fewer times per week. Eighty-four percent reported that they regularly took community pharmacists' phone calls, whereas 78% reported that they sometimes sought pharmacists' recommendations regarding their patients' drug therapy. Twenty-eight percent reported that they sometimes referred their patients to community pharmacists for medication reviews, with 44% unaware of such a service. There were no differences in physician readiness to engage in any of the 3 collaborative behaviors in urban versus rural settings. More accurate patient medication lists were perceived as the main advantage (pro) of collaborating with community pharmacists and pharmacists' lack of patient information as the main disadvantage (con). Collectively, perceived pros of collaboration were positive predictors of physician readiness to collaborate on all 3 behaviors, whereas perceived cons were negative predictors for the low- and mid-level behaviors. Female physicians were more likely than males to seek pharmacists' recommendations, whereas more experienced physicians were more likely to refer patients to pharmacists for medication reviews. Overall, Ontario physicians were more engaged in the low- and mid-level collaboration with community pharmacists with respect to drug therapy management. The strongest predictor of physician readiness to collaborate was perceived advantages of collaboration. Copyright © 2011 Elsevier Inc. All rights reserved.

The Reinvention of General Relativity: A Historiographical Framework for Assessing One Hundred Years of Curved Space-time.

PubMed

Blum, Alexander; Lalli, Roberto; Renn, M Jürgen

2015-09-01

The history of the theory of general relativity presents unique features. After its discovery, the theory was immediately confirmed and rapidly changed established notions of space and time. The further implications of general relativity, however, remained largely unexplored until the mid 1950s, when it came into focus as a physical theory and gradually returned to the mainstream of physics. This essay presents a historiographical framework for assessing the history of general relativity by taking into account in an integrated narrative intellectual developments, epistemological problems, and technological advances; the characteristics of post-World War II and Cold War science; and newly emerging institutional settings. It argues that such a framework can help us understand this renaissance of general relativity as a result of two main factors: the recognition of the untapped potential of general relativity and an explicit effort at community building, which allowed this formerly disparate and dispersed field to benefit from the postwar changes in the scientific landscape.

Process evaluation of a community-based intervention program: Healthy Youth Healthy Communities, an adolescent obesity prevention project in Fiji.

PubMed

Waqa, Gade; Moodie, Marj; Schultz, Jimaima; Swinburn, Boyd

2013-12-01

Nearly one-half of the adult population in Fiji between the ages of 15-64 years is either overweight or obese; and rates amongst school children have, on average, doubled during the last decade. There is an urgent need to scale up the promotion of healthy behaviors and environments using a multi-sectoral approach. The Healthy Youth Healthy Community (HYHC) project in Fiji used a settings approach in secondary schools and faith-based organizations to increase the capacity of the whole community, including churches, mosques and temples, to promote healthy eating and regular physical activity, and to prevent unhealthy weight gain in adolescents aged 13-18 years. The team consisted of a study manager, project coordinator and four research assistants (RAs) committed to planning, designing and facilitating the implementation of intervention programs in collaboration with other stakeholders, such as the wider school communities, government and non-governmental organizations and business partners. Process data were collected on all intervention activities and analyzed by dose, frequency and reach for each specific strategy. The Fiji Action Plan included nine objectives for the school settings; four were based on nutrition and two on physical activity in schools, plus three general objectives, namely capacity building, social marketing and evaluation. Long-term change in nutritional behavior was difficult to achieve; a key contributor to this was the unhealthy food served in the school canteens. Whilst capacity-building proved to be one of the best mechanisms for intervening, it is important to consider the cultural and social factors influencing health behaviors and affecting specific groups.

Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions.

PubMed

Sheridan, Janie; Stewart, Joanna; Smart, Ros; McCormick, Ross

2012-01-01

To estimate the prevalence of risky drinking among customers in community pharmacies and to explore customer attitudes towards screening and brief intervention (SBI). Cross-sectional, anonymous survey, using random selection of community pharmacies in New Zealand to collect data using self-completion questionnaires and an opportunity to enter a prize draw. Participants were customers/patients attending the community pharmacy on a specific, randomly selected day (Monday to Friday) in one set week. Alcohol Use Disorder Identification Test (AUDIT)-C using a cut-off score of 5 was used to measure risky drinking. Attitudes towards pharmacists engaging in SBI for risky drinkers were measured. 2384 completed customer/patient questionnaires from 43 participating pharmacies. Almost 84% ever drank alcohol and using a score of 5 or more as a cut-off, 30% of the sample would be considered as risky drinkers. Attitudes were generally positive to pharmacists undertaking SBI. Logistic regression with AUDIT-C positive or negative as the dependent variable found those taking medicines for mental health and liver disease being more likely to score negative on the AUDIT-C, and smokers and those purchasing hangover cures were more likely than average to have a positive AUDIT-C screen. This study indicates there is scope for community pharmacists to undertake SBI for risky drinking, and that customers find this to be acceptable. Targeted screening may well be useful, in particular for smokers. Further research is required to explore the effectiveness of SBI for risky drinkers in this setting. © 2011 Australasian Professional Society on Alcohol and other Drugs.

Implementing community-based provider participation in research: an empirical study

PubMed Central

2012-01-01

Background Since 2003, the United States National Institutes of Health (NIH) has sought to restructure the clinical research enterprise in the United States by promoting collaborative research partnerships between academically-based investigators and community-based physicians. By increasing community-based provider participation in research (CBPPR), the NIH seeks to advance the science of discovery by conducting research in clinical settings where most people get their care, and accelerate the translation of research results into everyday clinical practice. Although CBPPR is seen as a promising strategy for promoting the use of evidence-based clinical services in community practice settings, few empirical studies have examined the organizational factors that facilitate or hinder the implementation of CBPPR. The purpose of this study is to explore the organizational start-up and early implementation of CBPPR in community-based practice. Methods We used longitudinal, case study research methods and an organizational model of innovation implementation to theoretically guide our study. Our sample consisted of three community practice settings that recently joined the National Cancer Institute’s (NCI) Community Clinical Oncology Program (CCOP) in the United States. Data were gathered through site visits, telephone interviews, and archival documents from January 2008 to May 2011. Results The organizational model for innovation implementation was useful in identifying and investigating the organizational factors influencing start-up and early implementation of CBPPR in CCOP organizations. In general, the three CCOP organizations varied in the extent to which they achieved consistency in CBPPR over time and across physicians. All three CCOP organizations demonstrated mixed levels of organizational readiness for change. Hospital management support and resource availability were limited across CCOP organizations early on, although they improved in one CCOP organization. As a result of weak IPPs, all three CCOPs created a weak implementation climate. Patient accrual became concentrated over time among those groups of physicians for whom CBPPR exhibited a strong innovation-values fit. Several external factors influenced innovation use, complicating and enriching our intra-organizational model of innovation implementation. Conclusion Our results contribute to the limited body of research on the implementation of CBPPR. They inform policy discussions about increasing and sustaining community clinician involvement in clinical research and expand on theory about organizational determinants of implementation effectiveness. PMID:22568935

42 CFR 441.530 - Home and Community-Based Setting.

Code of Federal Regulations, 2014 CFR

2014-10-01

... section. (1) Home and community-based settings must have all of the following qualities, and such other qualities as the Secretary determines to be appropriate, based on the needs of the individual as indicated... work in competitive integrated settings, engage in community life, control personal resources, and...

Comparison of Rate of Utilization of Medicare Services in Private Versus Academic Cardiology Practice.

PubMed

Hovanesyan, Arsen; Rubio, Eduardo; Novak, Eric; Budoff, Matthew; Rich, Michael W

2017-11-15

Cardiovascular services are the third largest source of Medicare spending. We examined the rate of cardiovascular service utilization in the community of Glendale, CA, compared with the nearest academic medical center, the University of Southern California. Publicly available utilization data released by Medicare for the years 2012 and 2013 were used to identify all inpatient and outpatient cardiology services provided in each practice setting. The analysis included 19 private and 17 academic cardiologists. In unadjusted analysis, academic physicians performed half as many services per Medicare beneficiary per year as those in private practice: 2.3 versus 4.8, p <0.001. Other factors associated with higher utilization included male physician, international (vs US) medical school graduate, interventional (vs general) cardiologist, and more years in practice. Factors independently associated with higher utilization rates by multivariable analysis included private practice setting (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.30 to 2.61, p <0.001), male physician (OR 1.64, 95% CI 1.00 to 2.67, p = 0.049), and international medical school graduate (OR 1.37, 95% CI 1.07 to 1.78, p = 0.014). In conclusion, in this analysis of 2 cardiology practice settings in southern California, medical service utilization per Medicare beneficiary was nearly 2-fold higher in private practice than in the academic setting, suggesting that there may be opportunity for substantially reducing costs of cardiology care in the community setting. Copyright © 2017 Elsevier Inc. All rights reserved.

Understanding the Link between Social Organization and Crime in Rural Communities

PubMed Central

Chilenski, Sarah M.; Syvertsen, Amy K.; Greenberg, Mark T.

2015-01-01

Rural communities make up much of America's heartland, yet we know little about their social organization, and how elements of their social organization relate to crime rates. The current study sought to remedy this gap by examining the associations between two measures of social organization – collective efficacy and social trust – with a number of structural community characteristics, local crime rates, and perceptions of safety in a sample of 27 rural and small town communities in two states. Measures of collective efficacy, social trust, and perceived safety, were gathered from key community members in 2006; other measures were drawn from the 2000 Census and FBI Uniform Crime Reporting system. A series of competing hypotheses were tested to examine the relative importance of social trust and collective efficacy in predicting local crime rates. Results do not support the full generalization of the social disorganization model. Correlational analyses showed that neither collective efficacy nor social trust had a direct association with community crime, nor did they mediate the associations between community structural characteristics and crime. However, perceived safety mediated the association between community crime and both measures of social organization. Analyses suggest that social trust may be more important than collective efficacy when understanding the effect of crime on a community's culture in rural areas. Understanding these associations in rural settings can aid decision makers in shaping policies to reduce crime and juvenile delinquency. PMID:26120326

Parental bonding in men with alcohol disorders: a relationship with conduct disorder.

PubMed

Joyce, P R; Sellman, D; Wells, E; Frampton, C M; Bushnell, J A; Oakley-Browne, M; Hornblow, A R

1994-09-01

Men from a clinical treatment setting suffering from alcohol dependence, and randomly selected men from the community diagnosed as having alcohol abuse and/or dependence, completed the Parental Bonding Instrument. The men from the alcohol treatment setting perceived both parents as having been uncaring and overprotective. In the general population sample, an uncaring and overprotective parental style was strongly associated with childhood conduct disorder, but not with alcohol disorder symptoms. This discrepancy in perceived parenting highlights the difficulties in extrapolating findings about aetiological factors for alcohol disorders from clinical samples. It also suggests that childhood conduct disorder and adult antisocial behaviour could influence which men with alcohol disorders receive inpatient treatment.

Infectious disease transmission: survey of contacts between hospital-based healthcare workers and working adults from the general population.

PubMed

Jiang, Lili; Ng, Isabel Hui Leng; Hou, Yan'an; Li, Dunli; Tan, Linda Wei Lin; Ho, Hanley Jian An; Chen, Mark I-Cheng

2018-04-01

Healthcare workers (HCWs) may be the inadvertent interface between the healthcare setting and the community for infectious diseases transmission. To investigate HCWs' contacts during a work day and compare these against working adults from the general population. Prospective survey of contacts through 24 h self-reported diary in three public sector tertiary care hospitals and community-based working adults in Singapore. Participants were HCWs and working adults from the community. In all, 211 HCWs and 1028 working adults reported a total of 4066 and 9206 contacts. HCWs reported more work-related contacts than community-based working adults (median of 13 versus 4), and more contacts that were neither household nor work-related (1 versus 0) but fewer household contacts (2 versus 3). HCWs reported more work-related contacts involving physical contacts, and more new contacts particularly with short duration (≤15 min) compared to community-based working adults. Among different HCW types, doctors reported the highest whereas ward-based nurses reported the lowest total work-related contacts. Around half of ward-based and clinic-based nurses' contacts involved physical touch. Work-related contacts reported by clinic-based nurses, doctors, and assorted HCWs were shorter than in ward-based nurses, with a substantial number effectively occurring with new contacts. Institutional effects significant on univariate analyses were much reduced and non-significant after adjusting for confounding by HCW type. HCWs' contacts differ substantially from those of community-based working adults. HCWs may thus be at higher risk of acquiring and spreading contact-transmissible and respiratory infections due to the nature of their work. Whereas total number of contacts was fairly similar between HCW types, the characteristics of their contacts differed substantively. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Primary health care and general practice attachment: establishing an undergraduate teaching network in rural Greek health centers.

PubMed

Smyrnakis, Emmanouil; Gavana, Magda; Kondilis, Elias; Giannakopoulos, Stathis; Panos, Alexandros; Chainoglou, Athanasia; Stardeli, Thomai; Kavaka, Niki; Benos, Alexis

2013-01-01

Exposure of undergraduate medical students to general practice and community healthcare services is common practice in the international medical curricula. Nevertheless, proponents of the hospital and biotechnology based paradigm, which is still dominant within the medical academic environment, question both the scope and the setting of this training procedure. Regarding the latter, the quality of teaching is often questioned in settings such as rural primary health centers, where health professionals have neither incentives nor accredited training skills. Therefore, the success of community based medical education depends substantially on the procedures implemented to involve non-academic staff as clinical teachers. This report describes the steps taken by the Aristotle University of Thessaloniki (AUTH) Medical School to establish and maintain a Rural Primary Health Care (PHC) Teaching Network in order to implement community oriented PHC and GP undergraduate medical education. A multi-professional teachers' network of healthcare staff, working in Rural Primary Health Centers, has been chosen, in order to expose students to the holistic approach of PHC. The enrollment of teachers to the Teaching Network was solely on a voluntary basis. The novelty of this procedure is that each professional is approached personally, instead through the Health Center (HC) that usually offers this service as a package in similar activities. In an attempt to attract health professionals committed to medical education, a self-selection procedure was adopted. Collaboration with the medical school was established but it was characterized by the School's inability to compensate teachers. A series of 'Training the Trainers' seminars were completed during the first implementation period in order to enhance the awareness of health professionals regarding undergraduate teaching in PHC; to present the educational needs of medical students; to expose them to the principles of medical teaching; and to strengthen their communication skills. Setting up sustainable community oriented medical education activities in a more or less unfriendly environment is a difficult task that calls for wisely selected functional steps. Pilot educational activities determine the quality of the implemented programs by evaluating difficulties and constraints. Recruiting teachers on a voluntary basis proved to be critical in enhancing the quality of this educational activity, and overcoming distance constraints. The educational activities which were offered created a homogenous group of PHC teachers with explicit educational aims and objectives.

[Medical opinion leaders conflict of interests: effects of disclosures on the trust of the public and general practitioners].

PubMed

Chakroun, R; Milhabet, I

2011-08-01

Key medical opinion leaders influence the behaviors of physicians and patients. By law, they have to disclose their interests with pharmaceutical companies when they communicate in the media. Up to now, it appears that no study has explored the effect of opinion leaders' disclosures despite their potential impact on public health and economy. The study objective was to assess the effects of opinion leaders' disclosures of interest on the public and general practitioners' trust in opinion leader by comparison with the overall medical community. In an experimental setting, three opinion leader profiles were built that differed only by the disclosure of their interests (hidden vs. weak vs. strong interests). One of the three profiles was randomly assigned to the subjects of two groups: 67 students and 60 general practitioners. According to an Anova analysis, the main effects and interactions of the disclosure of interests, of the message recipients, and of the assessed targets on the level of trust were measured. The results show that the average level of trust expressed by general practitioners was lower than that expressed by the general public. The level of trust in the opinion leader was lower than that of the overall medical community. The level of trust of exposed subjects fell much lower with stronger disclosed interests. While the general public did not distinguish trust between opinion leaders and the overall medical community, practitioners showed a significantly lower level of trust in opinion leaders with increasingly strong levels of disclosed interests. These study results refute the assertion that public trust would be reduced by the disclosure of interests. They reinforce the importance of the "who judges who" and "which kind of disclosure impacts who ?" effects and draw attention to further research on the role of social interactions in both mass and group communications. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

What does locality commissioning in Avon offer? Retrospective descriptive evaluation.

PubMed Central

Hine, C. E.; Bachmann, M. O.

1997-01-01

OBJECTIVE: To describe the impact, direct costs of, and participants' attitudes to the first two years and eight months of locality commissioning in Avon. DESIGN: Retrospective description of programme. SETTING: Thirteen localities in Avon Health Authority area, covering 982000 population and 147 general practices. METHODS: Postal questionnaire survey of 147 general practitioners (one per practice); interviews with and questionnaire survey of 13 lead general practitioners and 13 so called link staff from the health authority. MAIN OUTCOME MEASURES: Locality initiatives, perceived influence, general practitioners' attitudes, management costs. RESULTS: Twenty initiatives were identified that had changed services to patients, and another nine were planned. The commonest initiatives concerned primary mental health care (seven), nurse specialists for primary care of chronic diseases (three), referral and clinical practice guidelines (seven), and access to hospital outpatient departments (one, with two others planned). Localities were more likely to have influenced the authority, trust managers, and consultants than social services, community health councils, and voluntary organisations. Activity varied between localities, lead general practitioners estimating that 120/147 (82%) of practices had been involved in locality meetings (range 44-100% in different localities). The authority had spent 6 p per capita on running the scheme, and the total time used by general practitioners for locality commissioning was estimated at 1.5 whole time equivalents. CONCLUSION: Locality commissioning has selectively changes services with limited extra funding and without delegation of hospital and community health service budgets. General practitioners wanted more policy and financial support. Further development should be based on evidence of costs, benefits, and limitations of locality commissioning schemes. PMID:9154029

Toward the International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set: A Minimal Generic Set of Domains for Rehabilitation as a Health Strategy.

PubMed

Prodinger, Birgit; Cieza, Alarcos; Oberhauser, Cornelia; Bickenbach, Jerome; Üstün, Tevfik Bedirhan; Chatterji, Somnath; Stucki, Gerold

2016-06-01

To develop a comprehensive set of the International Classification of Functioning, Disability and Health (ICF) categories as a minimal standard for reporting and assessing functioning and disability in clinical populations along the continuum of care. The specific aims were to specify the domains of functioning recommended for an ICF Rehabilitation Set and to identify a minimal set of environmental factors (EFs) to be used alongside the ICF Rehabilitation Set when describing disability across individuals and populations with various health conditions. Secondary analysis of existing data sets using regression methods (Random Forests and Group Lasso regression) and expert consultations. Along the continuum of care, including acute, early postacute, and long-term and community rehabilitation settings. Persons (N=9863) with various health conditions participated in primary studies. The number of respondents for whom the dependent variable data were available and used in this analysis was 9264. Not applicable. For regression analyses, self-reported general health was used as a dependent variable. The ICF categories from the functioning component and the EF component were used as independent variables for the development of the ICF Rehabilitation Set and the minimal set of EFs, respectively. Thirty ICF categories to be complemented with 12 EFs were identified as relevant to the identified ICF sets. The ICF Rehabilitation Set constitutes of 9 ICF categories from the component body functions and 21 from the component activities and participation. The minimal set of EFs contains 12 categories spanning all chapters of the EF component of the ICF. The identified sets proposed serve as minimal generic sets of aspects of functioning in clinical populations for reporting data within and across heath conditions, time, clinical settings including rehabilitation, and countries. These sets present a reference framework for harmonizing existing information on disability across general and clinical populations. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Process evaluation of a community-based adolescent obesity prevention project in Tonga

PubMed Central

2011-01-01

Background The rising burden of obesity in Tonga is alarming. The promotion of healthy behaviours and environments requires immediate urgent action and a multi-sectoral approach. A three-year community based study titled the Ma'alahi Youth Project (MYP) conducted in Tonga from 2005-2008 aimed to increase the capacity of the whole community (schools, churches, parents and adolescents) to promote healthy eating and regular physical activity and to reduce the prevalence of overweight and obesity amongst youth and their families. This paper reflects on the process evaluation for MYP, against a set of Best Practice Principles for community-based obesity prevention. Methods MYP was managed by the Fiji School of Medicine. A team of five staff in Tonga were committed to planning, implementation and evaluation of a strategic plan, the key planks of which were developed during a two day community workshop. Intervention activities were delivered in villages, churches and schools, on the main island of Tongatapu. Process evaluation data covering the resource utilisation associated with all intervention activities were collected, and analysed by dose, frequency and reach for specific strategies. The action plan included three standard objectives around capacity building, social marketing and evaluation; four nutrition; two physical activity objectives; and one around championing key people as role models. Results While the interventions included a wide mix of activities straddling across all of these objectives and in both school and village settings, there was a major focus on the social marketing and physical activity objectives. The intervention reach, frequency and dose varied widely across all activities, and showed no consistent patterns. Conclusions The adolescent obesity interventions implemented as part of the MYP program comprised a wide range of activities conducted in multiple settings, touched a broad spectrum of the population (wider than the target group), but the dose and frequency of activities were generally insufficient and not sustained. Also the project confirmed that, while the MYP resulted in increased community awareness of healthy behaviours, Tonga is still in its infancy in terms of conducting public health research and lacks research infrastructure and capacity. PMID:21549018

Process evaluation of a community-based adolescent obesity prevention project in Tonga.

PubMed

Fotu, Kalesita F; Moodie, Marj M; Mavoa, Helen M; Pomana, Siosifa; Schultz, Jimaima T; Swinburn, Boyd A

2011-05-09

The rising burden of obesity in Tonga is alarming. The promotion of healthy behaviours and environments requires immediate urgent action and a multi-sectoral approach. A three-year community based study titled the Ma'alahi Youth Project (MYP) conducted in Tonga from 2005-2008 aimed to increase the capacity of the whole community (schools, churches, parents and adolescents) to promote healthy eating and regular physical activity and to reduce the prevalence of overweight and obesity amongst youth and their families. This paper reflects on the process evaluation for MYP, against a set of Best Practice Principles for community-based obesity prevention. MYP was managed by the Fiji School of Medicine. A team of five staff in Tonga were committed to planning, implementation and evaluation of a strategic plan, the key planks of which were developed during a two day community workshop. Intervention activities were delivered in villages, churches and schools, on the main island of Tongatapu. Process evaluation data covering the resource utilisation associated with all intervention activities were collected, and analysed by dose, frequency and reach for specific strategies. The action plan included three standard objectives around capacity building, social marketing and evaluation; four nutrition; two physical activity objectives; and one around championing key people as role models. While the interventions included a wide mix of activities straddling across all of these objectives and in both school and village settings, there was a major focus on the social marketing and physical activity objectives. The intervention reach, frequency and dose varied widely across all activities, and showed no consistent patterns. The adolescent obesity interventions implemented as part of the MYP program comprised a wide range of activities conducted in multiple settings, touched a broad spectrum of the population (wider than the target group), but the dose and frequency of activities were generally insufficient and not sustained. Also the project confirmed that, while the MYP resulted in increased community awareness of healthy behaviours, Tonga is still in its infancy in terms of conducting public health research and lacks research infrastructure and capacity.

Recruitment, training outcomes, retention, and performance of community health advisors in two tobacco control interventions for Latinos.

PubMed

Woodruff, Susan I; Candelaria, Jeanette I; Elder, John P

2010-04-01

Community Health Advisors (CHAs) are indigenous lay health advisors who, with training, can create health awareness, disseminate health information and support behavior change in their communities. Little data are available that describe the characteristics, recruitment, training, retention, and performance of CHAs. The present study described the characteristics, recruitment process, training outcomes, retention activities, and performance of two sets of CHAs who delivered tobacco-related interventions in the local Latino community. The Tobacco Control in Latino Communities (TCLC) Center trained 35 CHAs to conduct either a smoking cessation program for Spanish-speaking adult smokers or a behavioral problem-solving intervention to reduce environmental tobacco smoke (ETS) exposure among low-income Latino children. Theoretical psychosocial constructs related to behavior change, general self-esteem, general self-efficacy, and demographics were collected from CHAs before and after training. Additional measures captured the level of professionalism exercised and effort undertaken by the CHAs, as well actual outcomes of their efforts. Of the 33 women and 2 men CHAs recruited, 86% were originally from Mexico, most had a high school education, most were married, and the average monthly household income was $1,100-$1,400. Mean participant age was 42 years, and level of acculturation was relatively low. There were changes in the desired direction pre-to-post training for both ETS and smoking cessation program CHAs for most of the psychosocial constructs. Expert ratings of CHA performance were good, and recipients of the CHAs' efforts showed positive changes in behavior. This information may aid in planning for recruitment and evaluation of CHAs for future tobacco control programs.

Hybrid Implementation Model of Community-Partnered Early Intervention for Toddlers with Autism: A Randomized Trial

ERIC Educational Resources Information Center

Shire, Stephanie Y.; Chang, Ya-Chih; Shih, Wendy; Bracaglia, Suzanne; Kodjoe, Maria; Kasari, Connie

2017-01-01

Background: Interventions found to be effective in research settings are often not as effective when implemented in community settings. Considering children with autism, studies have rarely examined the efficacy of laboratory-tested interventions on child outcomes in community settings using randomized controlled designs. Methods: One hundred and…

Feedback Mechanisms in Learning Virtual Community Settings

ERIC Educational Resources Information Center

Colazzo, Luigi; Comai, Alessio; Davi, Filippo; Molinari, Andrea; Villa, Nicola

2010-01-01

This paper introduces a set of services for the creation of on-line surveys, questionnaires, exams and self-assessment tests within a virtual community system used in e-learning settings. The system, called "Online Communities", is a dynamic web application used as platform for blended learning activities by the Faculty of Economics of…

The NCI Community Oncology Research Program: what every clinician needs to know.

PubMed

McCaskill-Stevens, Worta; Lyss, Alan P; Good, Marge; Marsland, Thomas; Lilenbaum, Rogerio

2013-01-01

Research in the community setting is essential for the translation of advances in cancer research into practice and improving cancer care for all populations. The National Cancer Institute is proposing a new community-based program, NCI Community Oncology Research Program (NCORP), which is the alignment of two existing programs, the Community Clinical Oncology Program, Minority-Based Community Clinical Oncology Program, and their Research Bases, and the National Cancer Institute's Community Cancer Centers Program. NCROP will support cancer control, prevention, treatment, and screening clinical trials and expand its research scope to include cancer care delivery research. Cancer disparities research will be integrated into studies across the continuum of NCORP research. Input from current NCI-funded community investigators provides critical insight into the challenges faced by oncology practices within various organizational structures. Furthermore, these investigators identify the resources, both administrative and clinical, that will be required in the community setting to support cancer care delivery research and to meet the requirements for a new generation of clinical research. The American Society for Clinical Oncology (ASCO) has initiated a forum to focus on the conduct of clinical research in the community setting. Resources are being developed to help practices in managing cancer care in community settings.

Improving infection control in general practice.

PubMed

Farrow, S C; Zeuner, D; Hall, C

1999-03-01

Infection control measures in the health care setting should protect patients and staff from cross-infection. The prevention of harm is an essential part of good medical practice and failure might result in professional misconduct proceedings by the General Medical Council (GMC) and prosecution under the Health and Safety at Work legislation, as well as civil liability. For a health authority, overall responsibility for public health includes arrangements for the control of communicable diseases and infection in hospital and the community (NHS Management Executive, 1993), a function usually led by the Consultant in Communicable Disease Control (CCDC). This paper describes one district's collaborative approach between public health and GPs to assess and improve local infection control standards.

Community Priorities for Healthy Eating in Older Adults.

PubMed

Jiang, Qianzhi; Cohen, Nancy L; Marra, Melissa Ventura; Woolf, Kathleen; Gilbride, Judith; Francis, Sarah L

2017-01-01

Community planners such as policymakers and health care and nutrition service providers can create an "age-friendly" environment to support healthy eating in older residents by addressing the highest priorities that enable older adults to improve their dietary intake through different food-related community settings. To identify and prioritize these factors that facilitate behavioral change (enablers) and behavioral settings important for older adult nutrition based on the social ecological model, nutrition and aging professionals (n = 30) from two rural (West Virginia, Iowa) and two urban (Massachusetts, New York) city/county regions (communities) participated in an online or live focus group discussion and completed an analytic hierarchy process survey online. Overall, the most important perceived enablers were accessibility and cost, followed by transportation and social support, but their relative importance varied by community. Participants from all communities considered congregate meal sites and food banks among the most important behavioral settings. Participants from most communities considered food stores to be important and also highlighted other settings unique to the area, such as senior housing, neighborhood, and farmers' markets. By targeting interventions to address the most notable enablers and behavioral settings specific to their community, planning groups can enhance their older residents' ability to achieve optimal nutritional health.

Development of a measure of sense of community for individuals with serious mental illness residing in community settings.

PubMed

Townley, Greg; Kloos, Bret

2009-03-03

The psychological sense of community is one of the most commonly investigated constructs in community psychology. Sense of community may be particularly important for individuals with serious mental illness (SMI) because they often face societal barriers to participation in community living, including stigma and discrimination. To date, no published studies have investigated the psychometric qualities of sense of community measures among individuals with SMI. The current study tested a series of confirmatory factor analyses using the Brief Sense of Community Index (BSCI, Long & Perkins, 2003) in a sample of 416 persons with SMI living in community settings to suggest a model of sense of community for individuals with SMI and other disabilities. The resulting scale, the Brief Sense of Community Index- Disability (BSCI-D), demonstrated good model fit and construct validity. Implications are discussed for how this scale may be used in research investigating community integration and adaptive functioning in community settings.

Development of a measure of sense of community for individuals with serious mental illness residing in community settings

PubMed Central

Townley, Greg; Kloos, Bret

2008-01-01

The psychological sense of community is one of the most commonly investigated constructs in community psychology. Sense of community may be particularly important for individuals with serious mental illness (SMI) because they often face societal barriers to participation in community living, including stigma and discrimination. To date, no published studies have investigated the psychometric qualities of sense of community measures among individuals with SMI. The current study tested a series of confirmatory factor analyses using the Brief Sense of Community Index (BSCI, Long & Perkins, 2003) in a sample of 416 persons with SMI living in community settings to suggest a model of sense of community for individuals with SMI and other disabilities. The resulting scale, the Brief Sense of Community Index- Disability (BSCI-D), demonstrated good model fit and construct validity. Implications are discussed for how this scale may be used in research investigating community integration and adaptive functioning in community settings. PMID:19305637

Perceptions of the Role of Short-Term Volunteerism in International Development: Views from Volunteers, Local Hosts, and Community Members.

PubMed

Loiseau, Bethina; Sibbald, Rebekah; Raman, Salem A; Darren, Benedict; Loh, Lawrence C; Dimaras, Helen

2016-01-01

Background. Short-term international volunteer trips traditionally involve volunteers from high-income countries travelling to low- and middle-income countries to assist in service-related development activities. Their duration typically ranges from 7 to 90 days. The city of La Romana, Dominican Republic, receives hundreds of short-term international volunteers annually. They participate in activities aimed at improving conditions faced by a marginalized ethnic-Haitian community living in bateyes. Methods. This qualitative analysis examined perceptions of short-term international volunteerism, held by three key stakeholder groups in La Romana: local hosts, international volunteers, and community members. Responses from semistructured interviews were recorded and analysed by thematic analysis. Results. Themes from the 3 groups were broadly categorized into general perceptions of short-term volunteerism and proposed best practices. These were further subdivided into perceptions of value, harms, and motivations associated with volunteer teams for the former and best practices around volunteer composition and selection, partnership, and skill sets and predeparture training for the latter. Conclusion. Notable challenges were associated with short-term volunteering, including an overemphasis on the material benefits from volunteer groups expressed by community member respondents; misalignment of the desired and actual skill sets of volunteers; duplicate and uncoordinated volunteer efforts; and the perpetuation of stereotypes suggesting that international volunteers possess superior knowledge or skills. Addressing these challenges is critical to optimizing the conduct of short-term volunteerism.

Perceptions of the Role of Short-Term Volunteerism in International Development: Views from Volunteers, Local Hosts, and Community Members

PubMed Central

Loiseau, Bethina; Sibbald, Rebekah; Raman, Salem A.; Darren, Benedict; Loh, Lawrence C.

2016-01-01

Background. Short-term international volunteer trips traditionally involve volunteers from high-income countries travelling to low- and middle-income countries to assist in service-related development activities. Their duration typically ranges from 7 to 90 days. The city of La Romana, Dominican Republic, receives hundreds of short-term international volunteers annually. They participate in activities aimed at improving conditions faced by a marginalized ethnic-Haitian community living in bateyes. Methods. This qualitative analysis examined perceptions of short-term international volunteerism, held by three key stakeholder groups in La Romana: local hosts, international volunteers, and community members. Responses from semistructured interviews were recorded and analysed by thematic analysis. Results. Themes from the 3 groups were broadly categorized into general perceptions of short-term volunteerism and proposed best practices. These were further subdivided into perceptions of value, harms, and motivations associated with volunteer teams for the former and best practices around volunteer composition and selection, partnership, and skill sets and predeparture training for the latter. Conclusion. Notable challenges were associated with short-term volunteering, including an overemphasis on the material benefits from volunteer groups expressed by community member respondents; misalignment of the desired and actual skill sets of volunteers; duplicate and uncoordinated volunteer efforts; and the perpetuation of stereotypes suggesting that international volunteers possess superior knowledge or skills. Addressing these challenges is critical to optimizing the conduct of short-term volunteerism. PMID:27382372

Priority setting in a Canadian surgical department: a case study using program budgeting and marginal analysis

PubMed Central

Mitton, Craig; Donaldson, Cam; Shellian, Barb; Pagenkopf, Cort

2003-01-01

Introduction A key mandate of Canadian regional health authorities is to set priorities and allocate resources within a limited funding envelope. The objective in this study was to determine how resources within a surgical program in a Canadian rural hospital might be reallocated to better meet the needs of the local community. Methods Early in 2001, at the Canmore General Hospital, Canmore, Alta., an expert-panel working group, consisting of a community health service leader, operating-room nurse clinician, acute care head nurse and a general surgeon, assisted by a research assistant and 2 health economists carried out a program budgeting and marginal analysis project to assess multiple data inputs into the decision-making process and to develop recommendations for service expansion and resource release. They considered the cost and benefits of altering the mix of resources used, based on Headwaters Health Authority activity and financial data, and local expert opinion. Results The primary recommendation was to implement an additional surgery day per week (38 days of major surgery and 12 days of minor surgery over a 50-week year). However, the total dollars to fund such an expansion could not be released from within the Canmore budget, and additional dollars were not forthcoming from the health region. A secondary objective of implementing an additional minor surgery day every 3 weeks was pursued and the required resources were obtained. Conclusions Due to resource constraints in health care, efforts by both clinicians and administrators should be made to better spend available resources. The marginal analysis process used in this study served as a useful framework for priority setting, which is generalizable to other surgical and nonsurgical programs in Canada. PMID:12585790

Coaching in Community Settings: A Review.

ERIC Educational Resources Information Center

Nettles, Saundra Murray

Coaching is a means of instruction that combines elements of mentoring and tutoring in natural community environments. Coach and student characteristics, processes of coaching, and outcomes of coaching in varied community settings and across different developmental levels are examined. Programs utilizing adults and peers from the community in…

Analysis of the quality of image data acquired by the LANDSAT-4 thematic mapper and multispectral scanners

NASA Technical Reports Server (NTRS)

Colwell, R. N. (Principal Investigator)

1983-01-01

The three types of LANDSAT 4 film products generally accessible to the user community were analyzed and attempts were made to acquire a data set consisting of a variety of TM and MSS image products for the Sacramento and San Francisco Bay Area test sites. On request, the EDC developed an interim TM analytical film by using a leaser beam recorder to produce black and white masters from which natural and false color composites were created.

Pilot climate data system

NASA Technical Reports Server (NTRS)

1985-01-01

A usable data base, the Pilot climate Data System (PCDS) is described. The PCDS is designed to be an interactive, easy-to-use, on-line generalized scientific information system. It efficiently provides uniform data catalogs; inventories, and access method, as well as manipulation and display tools for a large assortment of Earth, ocean and atmospheric data for the climate-related research community. Researchers can employ the PCDS to scan, manipulate, compare, display, and study climate parameters from diverse data sets. Software features, and applications of the PCDS are highlighted.

Three-dimensional viscous design methodology for advanced technology aircraft supersonic inlet systems

NASA Technical Reports Server (NTRS)

Anderson, B. H.

1983-01-01

A broad program to develop advanced, reliable, and user oriented three-dimensional viscous design techniques for supersonic inlet systems, and encourage their transfer into the general user community is discussed. Features of the program include: (1) develop effective methods of computing three-dimensional flows within a zonal modeling methodology; (2) ensure reasonable agreement between said analysis and selective sets of benchmark validation data; (3) develop user orientation into said analysis; and (4) explore and develop advanced numerical methodology.

Medieval monastic mortality: hazard analysis of mortality differences between monastic and nonmonastic cemeteries in England.

PubMed

DeWitte, Sharon N; Boulware, Jessica C; Redfern, Rebecca C

2013-11-01

Scholarship on life in medieval European monasteries has revealed a variety of factors that potentially affected mortality in these communities. Though there is some evidence based on age-at-death distributions from England that monastic males lived longer than members of the general public, what is missing from the literature is an explicit examination of how the risks of mortality within medieval monastic settings differed from those within contemporaneous lay populations. This study examines differences in the hazard of mortality for adult males between monastic cemeteries (n = 528) and non-monastic cemeteries (n = 368) from London, all of which date to between AD 1050 and 1540. Age-at-death data from all cemeteries are pooled to estimate the Gompertz hazard of mortality, and "monastic" (i.e., buried in a monastic cemetery) is modeled as a covariate affecting this baseline hazard. The estimated effect of the monastic covariate is negative, suggesting that individuals in the monastic communities faced reduced risks of dying compared to their peers in the lay communities. These results suggest better diets, the positive health benefits of religious behavior, better living conditions in general in monasteries, or selective recruitment of healthy or higher socioeconomic status individuals. Copyright © 2013 Wiley Periodicals, Inc.

Deciphering Diversity Indices for a Better Understanding of Microbial Communities.

PubMed

Kim, Bo-Ra; Shin, Jiwon; Guevarra, Robin; Lee, Jun Hyung; Kim, Doo Wan; Seol, Kuk-Hwan; Lee, Ju-Hoon; Kim, Hyeun Bum; Isaacson, Richard

2017-12-28

The past decades have been a golden era during which great tasks were accomplished in the field of microbiology, including food microbiology. In the past, culture-dependent methods have been the primary choice to investigate bacterial diversity. However, using cultureindependent high-throughput sequencing of 16S rRNA genes has greatly facilitated studies exploring the microbial compositions and dynamics associated with health and diseases. These culture-independent DNA-based studies generate large-scale data sets that describe the microbial composition of a certain niche. Consequently, understanding microbial diversity becomes of greater importance when investigating the composition, function, and dynamics of the microbiota associated with health and diseases. Even though there is no general agreement on which diversity index is the best to use, diversity indices have been used to compare the diversity among samples and between treatments with controls. Tools such as the Shannon- Weaver index and Simpson index can be used to describe population diversity in samples. The purpose of this review is to explain the principles of diversity indices, such as Shannon- Weaver and Simpson, to aid general microbiologists in better understanding bacterial communities. In this review, important questions concerning microbial diversity are addressed. Information from this review should facilitate evidence-based strategies to explore microbial communities.

Measuring sexual function in community surveys: development of a conceptual framework.

PubMed

Mitchell, Kirstin R; Wellings, Kaye

2013-01-01

Among the many psychometric measures of sexual (dys)function, none is entirely suited to use in community surveys. Faced with the need to include a brief and non-intrusive measure of sexual function in a general population survey, a new measure was developed. Findings from qualitative research with men and women in the community designed to inform the conceptual framework for this measure are presented. Thirty-two semi-structured interviews with individuals recruited from a general practice, an HIV/AIDS charity, and a sexual problems clinic were conducted. From their accounts, 31 potential criteria of a functional sex life were identified. Using evidence from qualitative data and the existing literature, and applying a set of decision rules, the list was reduced to 13 (eight for those not in a relationship), and a further eight criteria were added to enable individuals to self-rate their level of function and indicate the severity of difficulties. These criteria constitute a conceptual framework that is grounded in participant perceptions; is relevant to all, regardless of sexual experience or orientation; provides opportunity to state the degree of associated distress; and incorporates relational, psychological, and physiological aspects. It provides the conceptual basis for a concise and acceptable measure of sexual function.

Systematic Review of Community-Based Childhood Obesity Prevention Studies

PubMed Central

Segal, Jodi; Wu, Yang; Wilson, Renee; Wang, Youfa

2013-01-01

OBJECTIVE: This study systematically reviewed community-based childhood obesity prevention programs in the United States and high-income countries. METHODS: We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library for relevant English-language studies. Studies were eligible if the intervention was primarily implemented in the community setting; had at least 1 year of follow-up after baseline; and compared results from an intervention to a comparison group. Two independent reviewers conducted title scans and abstract reviews and reviewed the full articles to assess eligibility. Each article received a double review for data abstraction. The second reviewer confirmed the first reviewer’s data abstraction for completeness and accuracy. RESULTS: Nine community-based studies were included; 5 randomized controlled trials and 4 non–randomized controlled trials. One study was conducted only in the community setting, 3 were conducted in the community and school setting, and 5 were conducted in the community setting in combination with at least 1 other setting such as the home. Desirable changes in BMI or BMI z-score were found in 4 of the 9 studies. Two studies reported significant improvements in behavioral outcomes (1 in physical activity and 1 in vegetable intake). CONCLUSIONS: The strength of evidence is moderate that a combined diet and physical activity intervention conducted in the community with a school component is more effective at preventing obesity or overweight. More research and consistent methods are needed to understand the comparative effectiveness of childhood obesity prevention programs in the community setting. PMID:23753099

Preliminary assessment of factors influencing riverine fish communities in Massachusetts.

USGS Publications Warehouse

Armstrong, David S.; Richards, Todd A.; Brandt, Sara L.

2010-01-01

The U.S. Geological Survey, in cooperation with the Massachusetts Department of Conservation and Recreation (MDCR), Massachusetts Department of Environmental Protection (MDEP), and the Massachusetts Department of Fish and Game (MDFG), conducted a preliminary investigation of fish communities in small- to medium-sized Massachusetts streams. The objective of this investigation was to determine relations between fish-community characteristics and anthropogenic alteration, including flow alteration and impervious cover, relative to the effect of physical basin and land-cover (environmental) characteristics. Fish data were obtained for 756 fish-sampling sites from the Massachusetts Division of Fisheries and Wildlife fish-community database. A review of the literature was used to select a set of fish metrics responsive to flow alteration. Fish metrics tested include two fish-community metrics (fluvial-fish relative abundance and fluvial-fish species richness), and five indicator species metrics (relative abundance of brook trout, blacknose dace, fallfish, white sucker, and redfin pickerel). Streamflows were simulated for each fish-sampling site using the Sustainable Yield Estimator application (SYE). Daily streamflows and the SYE water-use database were used to determine a set of indicators of flow alteration, including percent alteration of August median flow, water-use intensity, and withdrawal and return-flow fraction. The contributing areas to the fish-sampling sites were delineated and used with a Geographic Information System (GIS) to determine a set of environmental characteristics, including elevation, basin slope, percent sand and gravel, percent wetland, and percent open water, and a set of anthropogenic-alteration variables, including impervious cover and dam density. Two analytical techniques, quantile regression and generalized linear modeling, were applied to determine the association between fish-response variables and the selected environmental and anthropogenic explanatory variables. Quantile regression indicated that flow alteration and impervious cover were negatively associated with both fluvial-fish relative abundance and fluvial-fish species richness. Three generalized linear models (GLMs) were developed to quantify the response of fish communities to multiple environmental and anthropogenic variables. Flow-alteration variables are statistically significant for the fluvial-fish relative-abundance model. Impervious cover is statistically significant for the fluvial-fish relative-abundance, fluvial-fish species richness, and brook trout relative-abundance models. The variables in the equations were demonstrated to be significant, and the variability explained by the models, as measured by the correlation between observed and predicted values, ranges from 39 to 65 percent. The GLM models indicated that, keeping all other variables the same, a one-unit (1 percent) increase in the percent depletion or percent surcharging of August median flow would result in a 0.4-percent decrease in the relative abundance (in counts per hour) of fluvial fish and that the relative abundance of fluvial fish was expected to be about 55 percent lower in net-depleted streams than in net-surcharged streams. The GLM models also indicated that a unit increase in impervious cover resulted in a 5.5-percent decrease in the relative abundance of fluvial fish and a 2.5-percent decrease in fluvial-fish species richness.

The Prevalence of Body Dysmorphic Disorder in Patients Undergoing Cosmetic Surgery: a Systematic Review.

PubMed

Panayi, Andreana

2015-09-01

Body dysmorphic disorder (BDD) is a somatoform disorder characterised by a distressing obsession with an imagined or slight appearance defect, which can significantly impair normal day-to-day functioning. Patients with BDD often first present, and are hence diagnosed, in cosmetic surgery settings. Several studies have investigated the prevalence rate of BDD in the general population or have done so for patients referring to cosmetic medical centers. To date, however, no review has been undertaken to compare the prevalence in the general community versus in a cosmetic surgery setting. Despite the lack of such a review it is a commonly held belief that BDD is more common in patients seeking cosmetic surgery. The current study aims to review the available literature in order to investigate whether BDD is indeed more prevalent in patients requesting cosmetic surgery, and if that is the case, to provide possible reasons for the difference in prevalence. In addition this review provides evidence on the effectiveness of cosmetic surgery as a treatment of BDD.

A pilot Internet "value of health" panel: recruitment, participation and compliance.

PubMed

Stein, Ken; Dyer, Matthew; Crabb, Tania; Milne, Ruairidh; Round, Alison; Ratcliffe, Julie; Brazier, John

2006-11-27

To pilot using a panel of members of the public to provide preference data via the Internet A stratified random sample of members of the general public was recruited and familiarized with the standard gamble procedure using an Internet based tool. Health states were periodically presented in "sets" corresponding to different conditions, during the study. The following were described: Recruitment (proportion of people approached who were trained); Participation (a) the proportion of people trained who provided any preferences and (b) the proportion of panel members who contributed to each "set" of values; and Compliance (the proportion, per participant, of preference tasks which were completed). The influence of covariates on these outcomes was investigated using univariate and multivariate analyses. A panel of 112 people was recruited. 23% of those approached (n = 5,320) responded to the invitation, and 24% of respondents (n = 1,215) were willing to participate (net = 5.5%). However, eventual recruitment rates, following training, were low (2.1% of those approached). Recruitment from areas of high socioeconomic deprivation and among ethnic minority communities was low. Eighteen sets of health state descriptions were considered over 14 months. 74% of panel members carried out at least one valuation task. People from areas of higher socioeconomic deprivation and unmarried people were less likely to participate. An average of 41% of panel members expressed preferences on each set of descriptions. Compliance ranged from 3% to 100%. It is feasible to establish a panel of members of the general public to express preferences on a wide range of health state descriptions using the Internet, although differential recruitment and attrition are important challenges. Particular attention to recruitment and retention in areas of high socioeconomic deprivation and among ethnic minority communities is necessary. Nevertheless, the panel approach to preference measurement using the Internet offers the potential to provide specific utility data in a responsive manner for use in economic evaluations and to address some of the outstanding methodological uncertainties in this field.

Weak interactions, omnivory and emergent food-web properties.

PubMed

Emmerson, Mark; Yearsley, Jon M

2004-02-22

Empirical studies have shown that, in real ecosystems, species-interaction strengths are generally skewed in their distribution towards weak interactions. Some theoretical work also suggests that weak interactions, especially in omnivorous links, are important for the local stability of a community at equilibrium. However, the majority of theoretical studies use uniform distributions of interaction strengths to generate artificial communities for study. We investigate the effects of the underlying interaction-strength distribution upon the return time, permanence and feasibility of simple Lotka-Volterra equilibrium communities. We show that a skew towards weak interactions promotes local and global stability only when omnivory is present. It is found that skewed interaction strengths are an emergent property of stable omnivorous communities, and that this skew towards weak interactions creates a dynamic constraint maintaining omnivory. Omnivory is more likely to occur when omnivorous interactions are skewed towards weak interactions. However, a skew towards weak interactions increases the return time to equilibrium, delays the recovery of ecosystems and hence decreases the stability of a community. When no skew is imposed, the set of stable omnivorous communities shows an emergent distribution of skewed interaction strengths. Our results apply to both local and global concepts of stability and are robust to the definition of a feasible community. These results are discussed in the light of empirical data and other theoretical studies, in conjunction with their broader implications for community assembly.

Temporal variability and social heterogeneity in disease transmission: the case of SARS in Hong Kong.

PubMed

Cori, Anne; Boëlle, Pierre-Yves; Thomas, Guy; Leung, Gabriel M; Valleron, Alain-Jacques

2009-08-01

The extent to which self-adopted or intervention-related changes in behaviors affect the course of epidemics remains a key issue for outbreak control. This study attempted to quantify the effect of such changes on the risk of infection in different settings, i.e., the community and hospitals. The 2002-2003 severe acute respiratory syndrome (SARS) outbreak in Hong Kong, where 27% of cases were healthcare workers, was used as an example. A stochastic compartmental SEIR (susceptible-exposed-infectious-removed) model was used: the population was split into healthcare workers, hospitalized people and general population. Super spreading events (SSEs) were taken into account in the model. The temporal evolutions of the daily effective contact rates in the community and hospitals were modeled with smooth functions. Data augmentation techniques and Markov chain Monte Carlo (MCMC) methods were applied to estimate SARS epidemiological parameters. In particular, estimates of daily reproduction numbers were provided for each subpopulation. The average duration of the SARS infectious period was estimated to be 9.3 days (+/-0.3 days). The model was able to disentangle the impact of the two SSEs from background transmission rates. The effective contact rates, which were estimated on a daily basis, decreased with time, reaching zero inside hospitals. This observation suggests that public health measures and possible changes in individual behaviors effectively reduced transmission, especially in hospitals. The temporal patterns of reproduction numbers were similar for healthcare workers and the general population, indicating that on average, an infectious healthcare worker did not infect more people than any other infectious person. We provide a general method to estimate time dependence of parameters in structured epidemic models, which enables investigation of the impact of control measures and behavioral changes in different settings.

Can Data be Organized for Science and Reuse?

NASA Astrophysics Data System (ADS)

Habermann, T.; Shasharina, S.; Jelenak, A.; Fillmore, D. W.

2015-12-01

The Data Life Cycle is an important general concept for thinking about data collection, management, and preservation practices across the geophysical scientific data community. The cycle generally spans the scientific process from ideation, through experimental design, observation collection, data analysis and visualization, publication, archive, distributions and eventual reuse. During the cycle, the data may change through new analyses, presentations, and responsible parties, but, historically, the format and organization of the data have generally remained the same. Data collected as a time series at a point remains as a time series and data collected/calculated as grids remains as grids. BIP is BIP and BSQ is BSQ. In fact, in many large data centers, the native format remains sacrosanct and, in the scientific community, reformatting is avoided because of fear of losing information or introducing data quality problems and irreproducible results. This traditional approach has worked well in areas where data are collected and used for a single purpose throughout the life cycle and domains where comparisons across different data sets are rare and problematic due to conflicting data organizational structures or incomplete documentation. This is not the world we live in today. Reuse for unexpected purposes and data (and model) comparisons are becoming increasingly common (e.g. climate model / observation comparisons). Data sets are preserved for future global investigators that may be unaware of the original project or purpose of the data. Also, it is becoming more common for data to be restructured and reformatted for particular problem or to support a flexible web service. Unfortunately, many of these efforts do not preserve the metadata that, hopefully, accompanies the data in the original format. In this presentation we will discuss alternative approaches to data management that will facilitate data reuse across teams and disciplines.

The association between alcohol outlet density and alcohol use among urban and regional Australian adolescents.

PubMed

Azar, Denise; White, Victoria; Coomber, Kerri; Faulkner, Agatha; Livingston, Michael; Chikritzhs, Tanya; Room, Robin; Wakefield, Melanie

2016-01-01

While recent evidence suggests that higher alcohol outlet density is associated with greater alcohol use among adolescents, influence of the four main outlet types on youth drinking within urban and regional communities is unknown. This study provides the first investigation of this relationship. Repeated cross-sectional surveys with random samples of secondary students clustered by school. Mixed-effects logistic regression analyses examined the association between each outlet type and the drinking outcomes, with interaction terms used to test urban/regional differences. Australia, 2002-11. Respondents participating in a triennial survey (aged 12-17 years); 44 897 from urban settings, 23 311 from regional settings. The key outcome measures were past month alcohol use, risky drinking among all students and risky drinking among past week drinkers. For each survey year, students were assigned a postcode-level outlet density (number of licences per 1000 population) for each outlet type (general, on-premise, off-premise, clubs). Interaction terms revealed a significant association between off-premises outlet density and risky drinking among all adolescents in urban (odds ratio = 1.36, 95% confidence interval CI = 1.05-1.75, P < 0.05) but not regional areas. Similarly, club density was associated with the drinking outcomes in urban communities only. General and on-premises density was associated with alcohol use and risky drinking among all adolescents. Higher densities of general, on- and off-premises outlets in an adolescent's immediate neighbourhood are related to increased likelihood of alcohol consumption among all adolescents. The density of licensed clubs is associated more strongly with drinking for urban than for regional adolescents. © 2015 Society for the Study of Addiction.

Research Foundations and Problems Regarding Counseling in the Community.

ERIC Educational Resources Information Center

Campbell, Robert E.

Research foundations and problems for counseling in the community are discussed. Research implications are outlined around Sarason's three challenges to community health; (1) extending therapeutic outreach, (2) studying those situations, settings, or forces in the community that set the stage for problems; and (3) efforts toward prevention.…

Perspective: General Education at the Community College, 1952-1978. Comparing Two Reports: General Education in Action--B. Lamar Johnson [and] General Education in a Changing Society--Miami-Dade Community College.

ERIC Educational Resources Information Center

Matthews, Donald R., Jr.

The values, goals, and organization of general education have been highly controversial subjects in higher education for years. Two different perspectives are provided by B. Lamar Johnson's "General Education in Action" (1952) and Miami-Dade Community College's (MDCC's) "General Education in a Changing Society" (1978). Concerns…

Utilisation of a community-based health facility in a low-income urban community in Ibadan, Nigeria

PubMed Central

Asuzu, Michael C.

2015-01-01

Background Primary healthcare is established to ensure that people have access to health services through facilities located in their community. However, utilisation of health facilities in Nigeria remains low in many communities. Aim To assess the utilisation of community-based health facility (CBHF) amongst adults in Ibadan, Nigeria Settings A low-income community in Ibadan North West Local Government Area of Oyo State. Methods A cross-sectional survey was conducted using a simple random sampling technique to select one adult per household in all 586 houses in the community. A semi-structured interviewer-administered questionnaire was used to collect information on respondents' sociodemographic characteristics, knowledge and utilisation of the CBHF. Data analysis included descriptive statistics and association testing using the Chi-square test at p = 0.05. Results The mean age of the respondents was 46.5 ± 16.0 years; 46.0% were men and 81.0% married; 26% had no formal education and 38.0% had secondary-level education and above; traders constituted 52.0% of the sample; and 85.2% were of low socioeconomic standing; 90% had patronised the CBHF. The main reasons for non-utilisation were preference for general hospitals (13.8%) and self-medication (12.1%). Respondents who had secondary education and above, were in a higher socioeconomic class, who had good knowledge of the facility and were satisfied with care, utilised the CBHF three months significantly more than their counterparts prior to the study (p < 0.05). However, only satisfaction with care was found to be a significant predictor of utilisation of the CBHF. Conclusion The utilisation of the CBHF amongst adults in the study setting is high, driven mostly by satisfaction with the care received previously. Self-medication, promoted by uncontrolled access to drugs through pharmacies and patent medicine stores, threatens this high utilisation. PMID:26245600

General patterns of niche construction and the management of ‘wild’ plant and animal resources by small-scale pre-industrial societies

PubMed Central

Smith, Bruce D.

2011-01-01

Niche construction efforts by small-scale human societies that involve ‘wild’ species of plants and animals are organized into a set of six general categories based on the shared characteristics of the target species and similar patterns of human management and manipulation: (i) general modification of vegetation communities, (ii) broadcast sowing of wild annuals, (iii) transplantation of perennial fruit-bearing species, (iv) in-place encouragement of economically important perennials, (v) transplantation and in-place encouragement of perennial root crops, and (vi) landscape modification to increase prey abundance in specific locations. Case study examples, mostly drawn from North America, are presented for each of the six general categories of human niche construction. These empirically documented categories of ecosystem engineering form the basis for a predictive model that outlines potential general principles and commonalities in how small-scale human societies worldwide have modified and manipulated their ‘natural’ landscapes throughout the Holocene. PMID:21320898

A soil alteration index based on phospholipid fatty acids.

PubMed

Puglisi, Edoardo; Nicelli, Marco; Capri, Ettore; Trevisan, Marco; Del Re, Attilio A M

2005-12-01

Phospholipid fatty acid (PLFA) analysis has gained great importance in the study of soil microbial community structure. This structure can give indication of the soil status. Purpose of the present paper is to analyse PLFA patterns in altered agricultural soils in order to develop a soil status alteration index. Soils subjected either to intensive agricultural exploitation, or to overflow by municipal and industrial wastes, or to irrigation with saline waters were analysed for PLFA content and compared to adjacent untreated soils by means of different statistical techniques. Principal component analysis separated PLFAs in three groups: unsaturated PLFAs (first axis, 48% of total variance), monounsaturated and cyclopropane PLFAs (second axis, 28% of total variance) and polyunsaturated PLFAs (third axis, 24% of total variance). By means of canonical discriminant analysis, a soil alteration index (SAI) was produced from 15 PLFAs using two data sets. A third data set was used to test the SAI general validity together with other data sets reported in literature. The index validity was confirmed in most cases: SAI gave higher scores for control soils and was generally able to classify soils according to their reported degree of alteration.

Caregiver Perspectives of Stigma Associated With Sickle Cell Disease in Adolescents.

PubMed

Wesley, Kimberly M; Zhao, Mimi; Carroll, Yvonne; Porter, Jerlym S

2016-01-01

Patients and families affected by various medical conditions report experiencing health-related stigma, which contributes to detrimental physical, psychological, and social outcomes. Sickle cell disease (SCD) is a genetic disorder that affects 89,000 individuals in the United States and is often associated with negative stereotypes and incorrect assumptions. The present study explored the perception of stigma as reported by caregivers of adolescents with SCD. Focus groups were conducted with 20 caregivers of patients with SCD. Focus groups were audio recorded and transcribed. The data were coded independently by two authors, and then reviewed conjointly until consensus was reached. Caregivers reported the perception of stigma in academic, medical, community, and family settings. They also reported internalized stigma including negative feelings toward having a child with SCD, feeling upset with others, and seeing negative emotions in their child due to SCD. Caregivers reported a general lack of knowledge about SCD across settings. These results demonstrated that stigma may affect individuals with SCD across multiple settings. These results also highlighted areas for intervention, with a focus on increasing communication and education toward medical providers, schools, and communities. Interventions can utilize technology, social media, and advertisement campaigns. Additionally, support groups for patients with SCD may help decrease stigma and validate patients' experiences. Copyright © 2016 Elsevier Inc. All rights reserved.

Medication Timing Errors for Parkinson's Disease: Perspectives Held by Caregivers and People with Parkinson's in New Zealand

PubMed Central

Buetow, Stephen; Henshaw, Jenny; Bryant, Linda; O'Sullivan, Deirdre

2010-01-01

Background. Common but seldom published are Parkinson's disease (PD) medication errors involving late, extra, or missed doses. These errors can reduce medication effectiveness and the quality of life of people with PD and their caregivers. Objective. To explore lay perspectives of factors contributing to medication timing errors for PD in hospital and community settings. Design and Methods. This qualitative research purposively sampled individuals with PD, or a proxy of their choice, throughout New Zealand during 2008-2009. Data collection involved 20 semistructured, personal interviews by telephone. A general inductive analysis of the data identified core insights consistent with the study objective. Results. Five themes help to account for possible timing adherence errors by people with PD, their caregivers or professionals. The themes are the abrupt withdrawal of PD medication; wrong, vague or misread instructions; devaluation of the lay role in managing PD medications; deficits in professional knowledge and in caring behavior around PD in formal health care settings; and lay forgetfulness. Conclusions. The results add to the limited published research on medication errors in PD and help to confirm anecdotal experience internationally. They indicate opportunities for professionals and lay people to work together to reduce errors in the timing of medication for PD in hospital and community settings. PMID:20975777

Developing theoretically based and culturally appropriate interventions to promote hepatitis B testing in 4 Asian American populations, 2006-2011.

PubMed

Maxwell, Annette E; Bastani, Roshan; Glenn, Beth A; Taylor, Victoria M; Nguyen, Tung T; Stewart, Susan L; Burke, Nancy J; Chen, Moon S

2014-05-01

Hepatitis B infection is 5 to 12 times more common among Asian Americans than in the general US population and is the leading cause of liver disease and liver cancer among Asians. The purpose of this article is to describe the step-by-step approach that we followed in community-based participatory research projects in 4 Asian American groups, conducted from 2006 through 2011 in California and Washington state to develop theoretically based and culturally appropriate interventions to promote hepatitis B testing. We provide examples to illustrate how intervention messages addressing identical theoretical constructs of the Health Behavior Framework were modified to be culturally appropriate for each community. Intervention approaches included mass media in the Vietnamese community, small-group educational sessions at churches in the Korean community, and home visits by lay health workers in the Hmong and Cambodian communities. Use of the Health Behavior Framework allowed a systematic approach to intervention development across populations, resulting in 4 different culturally appropriate interventions that addressed the same set of theoretical constructs. The development of theory-based health promotion interventions for different populations will advance our understanding of which constructs are critical to modify specific health behaviors.

Commentary on community-led total sanitation and human rights: should the right to community-wide health be won at the cost of individual rights?

PubMed

Bartram, Jamie; Charles, Katrina; Evans, Barbara; O'Hanlon, Lucinda; Pedley, Steve

2012-12-01

The Millennium Development Goals (MDGs) set out to halve the proportion of the population without access to basic sanitation between 1990 and 2015. The slow pace of progress has lead to a search for innovative responses, including social motivation approaches. One example of this type of approach is 'Community-led Total Sanitation' (CLTS). CLTS represents a major shift for sanitation projects and programmes in recognising the value of stopping open-defecation across the whole community, even when the individual toilets built are not necessarily wholly hygienic. However, recent publications on CLTS document a number of examples of practices which fail to meet basic ethical criteria and infringe human rights. There is a general theme in the CLTS literature encouraging the use of 'shame' or 'social stigma' as a tool for promoting behaviours. There are reported cases where monetary benefits to which individuals are otherwise entitled or the means to practice a livelihood are withheld to create pressures to conform. At the very extreme end of the scale, the investigation and punishment of violence has reportedly been denied if the crime occurred while defecating in the open, violating rights to a remedy and related access to justice. While social mobilisation in general, and CLTS in particular, have drastically and positively changed the way we think about sanitation, they neither need nor benefit from an association with any infringements of human rights.

Evaluating and Evolving Metadata in Multiple Dialects

NASA Astrophysics Data System (ADS)

Kozimor, J.; Habermann, T.; Powers, L. A.; Gordon, S.

2016-12-01

Despite many long-term homogenization efforts, communities continue to develop focused metadata standards along with related recommendations and (typically) XML representations (aka dialects) for sharing metadata content. Different representations easily become obstacles to sharing information because each representation generally requires a set of tools and skills that are designed, built, and maintained specifically for that representation. In contrast, community recommendations are generally described, at least initially, at a more conceptual level and are more easily shared. For example, most communities agree that dataset titles should be included in metadata records although they write the titles in different ways. This situation has led to the development of metadata repositories that can ingest and output metadata in multiple dialects. As an operational example, the NASA Common Metadata Repository (CMR) includes three different metadata dialects (DIF, ECHO, and ISO 19115-2). These systems raise a new question for metadata providers: if I have a choice of metadata dialects, which should I use and how do I make that decision? We have developed a collection of metadata evaluation tools that can be used to evaluate metadata records in many dialects for completeness with respect to recommendations from many organizations and communities. We have applied these tools to over 8000 collection and granule metadata records in four different dialects. This large collection of identical content in multiple dialects enables us to address questions about metadata and dialect evolution and to answer those questions quantitatively. We will describe those tools and results from evaluating the NASA CMR metadata collection.

Split diversity in constrained conservation prioritization using integer linear programming.

PubMed

Chernomor, Olga; Minh, Bui Quang; Forest, Félix; Klaere, Steffen; Ingram, Travis; Henzinger, Monika; von Haeseler, Arndt

2015-01-01

Phylogenetic diversity (PD) is a measure of biodiversity based on the evolutionary history of species. Here, we discuss several optimization problems related to the use of PD, and the more general measure split diversity (SD), in conservation prioritization.Depending on the conservation goal and the information available about species, one can construct optimization routines that incorporate various conservation constraints. We demonstrate how this information can be used to select sets of species for conservation action. Specifically, we discuss the use of species' geographic distributions, the choice of candidates under economic pressure, and the use of predator-prey interactions between the species in a community to define viability constraints.Despite such optimization problems falling into the area of NP hard problems, it is possible to solve them in a reasonable amount of time using integer programming. We apply integer linear programming to a variety of models for conservation prioritization that incorporate the SD measure.We exemplarily show the results for two data sets: the Cape region of South Africa and a Caribbean coral reef community. Finally, we provide user-friendly software at http://www.cibiv.at/software/pda.

Tweeting and Treating: How Hospitals Use Twitter to Improve Care.

PubMed

Gomes, Christian; Coustasse, Alberto

2015-01-01

Hospitals that have adopted Twitter primarily use it to share organizational news, provide general health care information, advertise upcoming community events, and foster networking. The purpose of this study was to explore the benefits that Twitter utilization has had in improving quality of care, access to care, patient satisfaction, and community footprint while assessing the barriers to its implementation. The methodology used was a qualitative study with a semistructured interview combined with a literature review, which followed the basic principles of a systematic review. The utilization of Twitter by hospitals suggest that it leads to savings of resources, enhanced employee and patient communication, and expanded patient reach in the community. Savings opportunities are generated by preventing unnecessary office visits, producing billable patient encounters, and eliminating high recruiting costs. Communication is enhanced using Twitter by sharing organizational content, news, and health promotions and can be also a useful tool during crises. The utilization of Twitter in the hospital setting has been more beneficial than detrimental in its ability to generate opportunities for cost savings, recruiting, communication with employees and patients, and community reach.

The SOMATICS collaborative: Introduction to a National Institute on Drug Abuse cooperative study of pharmacotherapy for opioid treatment in criminal justice settings.

PubMed

Chandler, Redonna K; Finger, Matthew S; Farabee, David; Schwartz, Robert P; Condon, Timothy; Dunlap, Laura J; Zarkin, Gary A; McCollister, Kathryn; McDonald, Ryan D; Laska, Eugene; Bennett, David; Kelly, Sharon M; Hillhouse, Maureen; Mitchell, Shannon G; O'Grady, Kevin E; Lee, Joshua D

2016-05-01

Among the nearly 750,000 inmates in U.S. jails, 12% report using opioids regularly, 8% report use in the month prior to their offense, and 4% report use at the time of their offense. Although ample evidence exists that medications effectively treat Opiate Use Disorder (OUD) in the community, strong evidence is lacking in jail settings. The general lack of medications for OUD in jail settings may place persons suffering from OUD at high risk for relapse to drug use and overdose following release from jail. The three study sites in this collaborative are pooling data for secondary analyses from three open-label randomized effectiveness trials comparing: (1) the initiation of extended-release naltrexone [XR-NTX] in Sites 1 and 2 and interim methadone in Site 3 with enhanced treatment-as usual (ETAU); (2) the additional benefit of patient navigation plus medications at Sites 2 and 3 vs. medication alone vs. ETAU. Participants are adults with OUD incarcerated in jail and transitioning to the community. We describe the rationale, specific aims, and designs of three separate studies harmonized to enhance their scientific yield to investigate how to best prevent jail inmates from relapsing to opioid use and associated problems as they transition back to the community. Conducting drug abuse research during incarceration is challenging and study designs with data harmonization across different sites can increase the potential value of research to develop effective treatments for individuals in jail with OUD. Published by Elsevier Inc.

An examination of the services provided by Psychiatric Consultation Liaison Nurses in a general hospital.

PubMed

Johnston, M L; Cowman, S

2008-08-01

The political, professional and economic context in which mental health care is delivered has witnessed significant changes in recent times. The movement of psychiatric patients from institutions to community settings has seen the emphasis of the loci of care delivery shifting with increasing numbers presenting to general hospitals. The speciality of the Psychiatric Consultation Liaison Nurse (PCLN) has emerged as a bridge between mental health and general hospital services. A descriptive, non-experimental research approach was employed to establish patient profiles and to provide an overview of the depth of service provision. This design was selected as the most appropriate because of the limited information on the PCLN in an Irish setting and secondly, as the study was limited to one rural geographical location. A questionnaire was utilized to collate the details of patients who had received a mental health assessment. The findings presented here are the profiles of patients assessed by the PCLN during the 3-month study period. The results add further credence to the existing evaluative studies in presenting the characteristics of patients within the Irish context and further contribute to the unique body of evidence that defines the mental health nurse in an advancing role.

Previous radiographic experience of children referred for dental extractions under general anaesthesia in the U.K.

PubMed

Young, N L; Rodd, H D; Craig, S A

2009-03-01

To determine what proportion of children undergo radiographic assessment prior to referral to a dental hospital for extractions under general anaesthesia. This prospective survey was conducted over a 6-month period. A data sheet was used to record the following information: patient's age; referrer's name and place of work (general dental practice or community dental service); teeth to be extracted (primary dentition and/or permanent dentition) and reported previous radiographic examination. Patients were excluded from the study if, following a clinical examination, radiographs were not actually deemed necessary for diagnosis and treatment planning purposes. Clinical setting A paediatric dentistry clinic within a dental hospital in the North of England. Participants 161 patients with a mean age of six years (SD = 2.2, range = 3-14 years) who were referred to the dental hospital for extractions under general anaesthesia. Overall, 12.4% of children had reportedly undergone a previous radiographic assessment prior to hospital referral. A significantly greater proportion of children referred for permanent tooth extractions had been subject to radiographic examination compared to children referred for primary tooth extractions (46.2% as compared to 6.3%; P = 0.001 chi-squared test). Furthermore, patients referred from the community dental service were significantly more likely to have had previous dental radiographs than children referred from general dental practice (36.9% compared to 9.3%; P = 0.003 chi-squared test). Radiographs do not appear to be routinely employed for caries diagnosis and treatment planning in young children within general dental practice in the U.K.

Contrasting prevalence of selection and drift in the community structuring of bacteria and microbial eukaryotes.

PubMed

Logares, Ramiro; Tesson, Sylvie V M; Canbäck, Björn; Pontarp, Mikael; Hedlund, Katarina; Rengefors, Karin

2018-05-04

Whether or not communities of microbial eukaryotes are structured in the same way as bacteria is a general and poorly explored question in ecology. Here, we investigated this question in a set of planktonic lake microbiotas in Eastern Antarctica that represent a natural community ecology experiment. Most of the analysed lakes emerged from the sea during the last 6,000 years, giving rise to waterbodies that originally contained marine microbiotas and that subsequently evolved into habitats ranging from freshwater to hypersaline. We show that habitat diversification has promoted selection driven by the salinity gradient in bacterial communities (explaining ∼72% of taxa turnover), while microeukaryotic counterparts were predominantly structured by ecological drift (∼72% of the turnover). Nevertheless, we also detected a number of microeukaryotes with specific responses to salinity, indicating that albeit minor, selection has had a role in the structuring of specific members of their communities. In sum, we conclude that microeukaryotes and bacteria inhabiting the same communities can be structured predominantly by different processes. This should be considered in future studies aiming to understand the mechanisms that shape microbial assemblages. This article is protected by copyright. All rights reserved. © 2018 Society for Applied Microbiology and John Wiley & Sons Ltd.

Maximizing value and minimizing barriers: Patient-centered community consultation for research in emergency settings.

PubMed

Fordyce, Christopher B; Roe, Matthew T; Dickert, Neal W

2017-02-01

Patients with cardiac arrest and other life-threatening emergencies are unable to provide prospective consent for clinical trials. In the United States and other countries, regulations permit an exception from the requirement for informed consent in emergency settings. However, many potential barriers exist, as evidenced by the scarcity of US trials conducted under exception from the requirement for informed consent. One persistent challenge is the requirement that investigators consult communities prior to study approval. To improve the community consultation process for emergency studies under exception from the requirement for informed consent, we propose that prioritizing engagement of individuals who have experienced the condition under study, or are at high risk for the condition, fulfills regulatory goals and represents the interests of potential enrollees and the community without impeding research. Prioritizing patients engages individuals who are more likely to understand the concerns and experiences of study subjects, to appreciate risks and benefits of the study, and to understand the impact of the disease and intervention on patients' lives than are members of the general public. Similarly, those explicitly at high risk are more likely to identify as potential participants and may impart some level of accountability on the investigator. Finally, the most logical community of relevance is defined by a combination of condition-related experience and living in the area where a study will be conducted; geographic and condition-related communities should not be treated as distinct. In this sense, patients, their family members, and individuals at high risk within the catchment area represent the appropriate "community." Exception from the requirement for informed consent regulations have advanced the goal of improving care for emergency conditions, but common interpretations of the community consultation requirement threaten research in the United States. Focusing on the goals of learning from and demonstrating respect for those most directly affected by a study through engaging people most connected to the condition of interest will make community consultation more valuable, better inform institutional review boards, and increase efficiency.

General aviation and community development

NASA Technical Reports Server (NTRS)

Sincoff, M. Z. (Editor); Dajani, J. S. (Editor)

1975-01-01

The summer program is summarized. The reports presented concern (1) general aviation components, (2) general aviation environment, (3) community perspective, and (4) transportation and general aviation in Virginia.

The emerging role of faith community nurses in prevention and management of chronic disease.

PubMed

McGinnis, Sandra L; Zoske, Frances M

2008-08-01

Faith community nursing, formerly known as parish nursing, is one model of care that relies heavily on older registered nurses (RNs) to provide population-based and other nonclinical services in community settings. Faith community nursing provides services not commonly available in the traditional health care system (e.g., community case management, community advocacy, community health education). With appropriate support, this model of nursing could be expanded into other settings within the community and has the potential to draw on the skills of experienced RNs to provide communities with services that address unmet health care needs.

Refuah Shlema: a cross-cultural programme for promoting communication and health among Ethiopian immigrants in the primary health care setting in Israel: evidence and lessons learned from over a decade of implementation.

PubMed

Levin-Zamir, Diane; Keret, Sandra; Yaakovson, Orit; Lev, Boaz; Kay, Calanit; Verber, Giora; Lieberman, Niki

2011-03-01

The Refuah Shlema programme was established to reduce health disparities, promote health literacy and health indicators of the Ethiopian immigrant community in Israel, and included: (i) integrating Ethiopian immigrant liaisons in primary care as inter-cultural mediators; (ii) in-service training of clinical staff to increase cultural awareness and sensitivity; and (iii) health education community activities. Qualitative and quantitative evidence showed improvements in: (i) clinic staff–patient relations; (ii) availability and accessibility of health services, and health system navigation without increasing service expenditure; (iii) perception of general well-being; and (iv) self-care practice with regards to chronic conditions. Evidence significantly contributed to sustaining the programme for over 13 years.

ORCID Uptake in the Astronomical Community

NASA Astrophysics Data System (ADS)

Holmquist, Jane

2015-08-01

The IAU General Assembly provides librarians with a unique opportunity to interact with astronomers from all over the world. From the perspective of an ORCID Ambassador, the Focus Group Meeting on "Scholarly Publication in Astronomy" also provides an opportunity to demonstrate the cooperation and collaboration needed by individual astronomers, societies, librarians, publishers and bibliographic database providers to achieve universal adoption of ORCID, a standard unique identifier for authors, just as the DOI (digital object identifier) has been adopted for each journal article published.I propose to 1) present at the Focus Group Meeting an update on the uptake of ORCID by members of the astronomical community and 2) set up a small station (TBA) near the IAU registration area where librarians can show researchers how to register for an ORCID in 30 seconds.

Water-quality assessment of part of the Upper Mississippi River Basin Study Unit, Minnesota and Wisconsin- Nutrients, chlorophyll a, phytoplankton, and suspended sediment in streams, 1996-98

USGS Publications Warehouse

Kroening, Sharon E.; Lee, Kathy E.; Goldstein, R.M.

2003-01-01

The greatest chlorophyll-a concentrations and algal abundances generally were measured in the Little Cobb River near Beauford, Minnesota; Minnesota River near Jordan, Minnesota; Mississippi River at Hastings, Minnesota; and the Mississippi River at Red Wing, Minnesota. Greater concentrations and algal abundances at these sites may have been the result of increased nitrogen and phosphorus concentrations. Total phosphorus concentrations at these sites most frequently exceeded the goal of 0.1 mg/L set by the USEPA to prevent eutrophication. Phytoplankton communities at these sites primarily were dominated by blue-green algae during the summer of 1996. In contrast, at most of the other sites, the phytoplankton community was dominated by diatoms.

How Can a Global Social Support System Hope to Achieve Fairer Competiveness? Comment on "A Global Social Support System: What the International Community Could Learn From the United States' National Basketball Association".

PubMed

Goldblatt, Peter

2015-12-25

Ooms et al sets out some good general principles for a global social support system to improve fairer global competitiveness as a result of redistribution. This commentary sets out to summarize some of the conditions that would need to be satisfied for it to level up gradients in inequality through such a social support system, using the National Basketball Association (NBA) example as a point of reference. From this, the minimal conditions are described that would be required for the support system, proposed in the article by Ooms et al, to succeed. © 2016 by Kerman University of Medical Sciences.

The FIRE Project

NASA Technical Reports Server (NTRS)

Mcdougal, D.

1986-01-01

The International Satellite Cloud Climatology Project's (ISCCP) First ISCCP Regional Experiment (FIRE) project is a program to validate the cloud parameters derived by the ISCCP. The 4- to 5-year program will concentrate on clouds in the continental United States, particularly cirrus and marine stratocumulus clouds. As part of the validation process, FIRE will acquire satellite, aircraft, balloon, and surface data. These data (except for the satellite data) will be amalgamated into one common data set. Plans are to generate a standardized format structure for use in the PCDS. Data collection will begin in April 1986, but will not be available to the general scientific community until 1987 or 1988. Additional pertinent data sets already reside in the PCDS. Other qualifications of the PCDS for use in this validation program were enumerated.

Comparison of Primer Sets for Use in Automated Ribosomal Intergenic Spacer Analysis of Aquatic Bacterial Communities: an Ecological Perspective▿

PubMed Central

Jones, Stuart E.; Shade, Ashley L.; McMahon, Katherine D.; Kent, Angela D.

2007-01-01

Two primer sets for automated ribosomal intergenic spacer analysis (ARISA) were used to assess the bacterial community composition (BCC) in Lake Mendota, Wisconsin, over 3 years. Correspondence analysis revealed differences in community profiles generated by different primer sets, but overall ecological patterns were conserved in each case. ARISA is a powerful tool for evaluating BCC change through space and time, regardless of the specific primer set used. PMID:17122397

Report of the Special Task Force to Study Not-for-Profit Hospitals and Unsponsored Charity Care.

PubMed

Anderson, R J; Milburn, L T

1990-04-01

Texas not-for-profit hospitals recently received intense scrutiny regarding their involvement in charity-related contributions when Texas Attorney General Jim Mattox formed the Task Force to Study Not-for-Profit Hospitals and Unsponsored Charity Care. This article details the task force's recommendations concerning charity care obligations of Texas not-for-profit hospitals. Setting the stage for these recommendations was a broad definition of charitable services that included costs for delivering services to indigents and for providing community services to fulfill the hospital's charitable, religious, educational, research, or eleemosynary purposes. The task force unanimously agreed that a mandated level of charity care was incongruent with the hospitals' individual missions and specific community needs, but they supported the formation of standard accounting procedures for charitable services and the voluntary submission of their mission statements to the attorney general of Texas. While the hospitals' role in providing charitable services is very important, the task force emphasized that the overall need for adequate financing and reimbursement of health care is a societal problem that needs specific state and federal actions.

Measuring and Examining General Self-Efficacy among Community College Students: A Structural Equation Modeling Approach

ERIC Educational Resources Information Center

Chen, Yu; Starobin, Soko S.

2018-01-01

This study examined a psychosocial mechanism of how general self-efficacy interacts with other key factors and influences degree aspiration for students enrolled in an urban diverse community college. Using general self-efficacy scales, the authors hypothesized the General Self-efficacy model for Community College students (the GSE-CC model). A…

Sustaining Family Physicians in Urban Underserved Settings.

PubMed

Getzin, Anne; Bobot, Bonnie L; Simpson, Deborah

2016-11-01

Our objective was to identify factors that sustain family physicians practicing in Milwaukee's underserved urban areas. Family physicians with clinical careers in Milwaukee's urban, underserved communities were identified and invited to participate in a 45-60 minute interview using a literature-based semi-structured protocol. Each interview was transcribed and de-identified prior to independent analysis using a grounded theory qualitative approach by two authors to yield sustaining themes. The project was determined not human subjects research per Aurora Health Care IRB. Sixteen family physicians were identified; six of 11 who met inclusion criteria agreed to interview. Four general domains central to sustaining family physicians working with underserved populations were identified: (1) cognitive traits and qualities (trouble shooting, resilience, flexibility), (2) core values (medicine as mechanism to address social justice), (3) skills (self-care, communication, clinical management), and (4) support systems (supportive family/employer, job flexibility, leadership opportunities, staff function as team). The formation of these personal attributes and skills was partly shaped by experiences (from childhood to medical training to work experience) and by personal drivers that varied by individual. Common was that the challenges of providing care in urban underserved settings was seen as rewarding in and of itself and aligned with these physicians' values and skills. Family physicians working with underserved populations described possessing a combination of values, cognitive qualities, skill sets, and support systems. While family physicians face complex challenges in quality care goals in urban underserved settings, training in the personal and professional skill sets identified by participants may improve physician retention in such communities.

Environmental Profile of a Community’s Health (EPOCH): An Ecometric Assessment of Measures of the Community Environment Based on Individual Perception

PubMed Central

Corsi, Daniel J.; Subramanian, S. V.; McKee, Martin; Li, Wei; Swaminathan, Sumathi; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Lear, Scott A.; Dagenais, Gilles; Rangarajan, Sumathy; Teo, Koon; Yusuf, Salim; Chow, Clara K.

2012-01-01

Background Public health research has turned towards examining upstream, community-level determinants of cardiovascular disease risk factors. Objective measures of the environment, such as those derived from direct observation, and perception-based measures by residents have both been associated with health behaviours. However, current methods are generally limited to objective measures, often derived from administrative data, and few instruments have been evaluated for use in rural areas or in low-income countries. We evaluate the reliability of a quantitative tool designed to capture perceptions of community tobacco, nutrition, and social environments obtained from interviews with residents in communities in 5 countries. Methodology/ Principal Findings Thirteen measures of the community environment were developed from responses to questionnaire items from 2,360 individuals residing in 84 urban and rural communities in 5 countries (China, India, Brazil, Colombia, and Canada) in the Environmental Profile of a Community’s Health (EPOCH) study. Reliability and other properties of the community-level measures were assessed using multilevel models. High reliability (>0.80) was demonstrated for all community-level measures at the mean number of survey respondents per community (n = 28 respondents). Questionnaire items included in each scale were found to represent a common latent factor at the community level in multilevel factor analysis models. Conclusions/ Significance Reliable measures which represent aspects of communities potentially related to cardiovascular disease (CVD)/risk factors can be obtained using feasible sample sizes. The EPOCH instrument is suitable for use in different settings to explore upstream determinants of CVD/risk factors. PMID:22973446

Opportunities and barriers in paediatric pulse oximetry for pneumonia in low-resource clinical settings: a qualitative evaluation from Malawi and Bangladesh

PubMed Central

Boyd, Nicholas; Walker, Isabeau; Zadutsa, Beatiwel; Baqui, Abdullah H; Ahmed, Salahuddin; Islam, Mazharul; Kainja, Esther; Nambiar, Bejoy; Wilson, Iain; McCollum, Eric D

2018-01-01

Objective To gain an understanding of what challenges pulse oximetry for paediatric pneumonia management poses, how it has changed service provision and what would improve this device for use across paediatric clinical settings in low-income countries. Design Focus group discussions (FGDs), with purposive sampling and thematic analysis using a framework approach. Setting Community, front-line outpatient, and hospital outpatient and inpatient settings in Malawi and Bangladesh, which provide paediatric pneumonia care. Participants Healthcare providers (HCPs) from Malawi and Bangladesh who had received training in pulse oximetry and had been using oximeters in routine paediatric care, including community healthcare workers, non-physician clinicians or medical assistants, and hospital-based nurses and doctors. Results We conducted six FGDs, with 23 participants from Bangladesh and 26 from Malawi. We identified five emergent themes: trust, value, user-related experience, sustainability and design. HCPs discussed the confidence gained through the use of oximeters, resulting in improved trust from caregivers and valuing the device, although there were conflicts between the weight given to clinical judgement versus oximeter results. HCPs reported the ease of using oximeters, but identified movement and physically smaller children as measurement challenges. Challenges in sustainability related to battery durability and replacement parts, however many HCPs had used the same device longer than 4 years, demonstrating robustness within these settings. Desirable features included back-up power banks and integrated respiratory rate and thermometer capability. Conclusions Pulse oximetry was generally deemed valuable by HCPs for use as a spot-check device in a range of paediatric low-income clinical settings. Areas highlighted as challenges by HCPs, and therefore opportunities for redesign, included battery charging and durability, probe fit and sensitivity in paediatric populations. Trial registration number NCT02941237. PMID:29382679

The pilot climate data system

NASA Technical Reports Server (NTRS)

Reph, M. G.; Treinish, L. A.; Smith, P. H.

1984-01-01

The Pilot Climate Data System (PCDS) is an interactive scientific information management system for locating, obtaining, manipulating, and displaying climate-research data. The PCDS was developed to manage a large collection of data of interest to the National Aeronautics and Space Administration's (NASA) research community and currently provides such support for approximately twenty data sets. In order to provide the PCDS capabilities, NASA's Goddard Space Flight Center (NASA/GSFC) has integrated the capabilities of several general-purpose software packages with specialized software for reading and reformatting the supported data sets. These capabilities were integrated in a manner which allows the PCDS to be easily expanded, either to provide support for additional data sets or to provide additional functional capabilities. This also allows the PCDS to take advantage of new technology as it becomes available, since parts of the system can be replaced with more powerful components without significantly affecting the user interface.

Reliability of community health worker collected data for planning and policy in a peri-urban area of Kisumu, Kenya.

PubMed

Otieno, C F; Kaseje, D; Ochieng', B M; Githae, M N

2012-02-01

A general introduction of this article is as follows: Reliable and timely health information is an essential foundation of public health action and health systems strengthening, both nationally and internationally (Aqil et al. in Health Policy Plan 24(3): 217-228, 2009; Bradshaw et al. in initial burden of disease estimates for South Africa, 2000. South African Medical Research Council, Cape Town, 2003). The need for sound information is especially urgent in the case of emergent diseases and other acute health threats, where rapid awareness, investigation and response can save lives and prevent broader national outbreaks and even global pandemics (Aqil et al. in Health Policy Plan 24(3): 217-228, 2009). The government of Kenya, through the ministry of public health and sanitation has rolled out the community health strategy as a way of improving health care at the household level. This involves community health workers collecting health status data at the household level, which is then used for dialogue at all the levels to inform decisions and actions towards improvement in health status. A lot of health interventions have involved the community health workers in reaching out to the community, hence successfully implementing these health interventions. Large scale involvement of community health workers in government initiatives and most especially to collect health data for use in the health systems has been minimal due to the assumption that the data may not be useful to the government, because its quality is uncertain. It was therefore necessary that the validity and reliability of the data collected by community health workers be determined, and whether this kind of data can be used for planning and policy formulation for the communities from which it is collected. This would go a long way to settle speculation on whether the data collected by these workers is valid and reliable for use in determining the health status, its causes and distribution, of a community. Our general objective of this article is to investigate the validity and reliability of Community Based Information, and we deal with research question "What is the reliability of data collected at the Community level by Community health workers?". The methods which we use to find an reliable answer to this question is "Ten percent of all households visited by CHWs for data collection were recollected by a technically trained team. Test/retest method was applied to the data to establish reliability. The Kappa score, sensitivity, specificity and positive predictive values were also used to measure reliability". Finally our findings are as follows: Latrine availability and Antenatal care presented good correspondence between the two sets of data. This was also true for exclusive breast feeding indicator. Measles immunization coverage showed less consistency than the rest of the child health indicators. At last we conclude and recommend that CHWs can accurately and reliably collect household data which can be used for health decisions and actions especially in resource poor settings where other approaches to population based data are too expensive.

The Setting is the Service: How the Architecture of Sober Living Residences Supports Community Based Recovery

PubMed Central

Wittman, Fried; Jee, Babette; Polcin, Douglas L.; Henderson, Diane

2014-01-01

The architecture of residential recovery settings is an important silent partner in the alcohol/drug recovery field. The settings significantly support or hinder recovery experiences of residents, and shape community reactions to the presence of sober living houses (SLH) in ordinary neighborhoods. Grounded in the principles of Alcoholics Anonymous, the SLH provides residents with settings designed to support peer based recovery; further, these settings operate in a community context that insists on sobriety and strongly encourages attendance at 12-step meetings. Little formal research has been conducted to show how architectural features of the recovery setting – building appearance, spatial layouts, furnishings and finishes, policies for use of the facilities, physical care and maintenance of the property, neighborhood features, aspects of location in the city – function to promote (or retard) recovery, and to build (or detract from) community support. This paper uses a case-study approach to analyze the architecture of a community-based residential recovery service that has demonstrated successful recovery outcomes for its residents, is popular in its community, and has achieved state-wide recognition. The Environmental Pattern Language (Alexander, Ishikawa, & Silverstein, 1977) is used to analyze its architecture in a format that can be tested, critiqued, and adapted for use by similar programs in many communities, providing a model for replication and further research. PMID:25328377

The Setting is the Service: How the Architecture of Sober Living Residences Supports Community Based Recovery.

PubMed

Wittman, Fried; Jee, Babette; Polcin, Douglas L; Henderson, Diane

2014-07-01

The architecture of residential recovery settings is an important silent partner in the alcohol/drug recovery field. The settings significantly support or hinder recovery experiences of residents, and shape community reactions to the presence of sober living houses (SLH) in ordinary neighborhoods. Grounded in the principles of Alcoholics Anonymous, the SLH provides residents with settings designed to support peer based recovery; further, these settings operate in a community context that insists on sobriety and strongly encourages attendance at 12-step meetings. Little formal research has been conducted to show how architectural features of the recovery setting - building appearance, spatial layouts, furnishings and finishes, policies for use of the facilities, physical care and maintenance of the property, neighborhood features, aspects of location in the city - function to promote (or retard) recovery, and to build (or detract from) community support. This paper uses a case-study approach to analyze the architecture of a community-based residential recovery service that has demonstrated successful recovery outcomes for its residents, is popular in its community, and has achieved state-wide recognition. The Environmental Pattern Language (Alexander, Ishikawa, & Silverstein, 1977) is used to analyze its architecture in a format that can be tested, critiqued, and adapted for use by similar programs in many communities, providing a model for replication and further research.

Associations between participation in organised physical activity in the school or community outside school hours and neighbourhood play with child physical activity and sedentary time: a cross-sectional analysis of primary school-aged children from the UK

PubMed Central

Macdonald-Wallis, Corrie; Solomon-Moore, Emma; Thompson, Janice, L.; Lawlor, Debbie, A.; Sebire, Simon, J.

2017-01-01

Objectives To assess the extent to which participation in organised physical activity in the school or community outside school hours and neighbourhood play was associated with children’s physical activity and sedentary time. Design Cross-sectional study. Setting Children were recruited from 47 state-funded primary schools in South West England. Participants 1223 children aged 8–9 years old. Outcome measures Accelerometer-assessed moderate-to-vigorous-intensity physical activity (MVPA) and sedentary time. Methods Children wore an accelerometer, and the mean minutes of MVPA and sedentary time per day were derived. Children reported their attendance at organised physical activity in the school or community outside school hours and neighbourhood play using a piloted questionnaire. Cross-sectional linear and logistic regression were used to examine if attendance frequency at each setting (and all settings combined) was associated with MVPA and sedentary time. Multiple imputation methods were used to account for missing data and increase sample size. Results Children who attended clubs at school 3–4 days per week obtained an average of 7.58 (95% CI 2.7 to 12.4) more minutes of MVPA per day than children who never attended. Participation in the three other non-school-based activities was similarly associated with MVPA. Evidence for associations with sedentary time was generally weaker. Associations were similar in girls and boys. When the four different contexts were combined, each additional one to two activities participated in per week increased participants’ odds (OR: 1.18, 95% CI 1.12 to 1.25) of meeting the government recommendations for 60 min of MVPA per day. Conclusion Participating in organised physical activity at school and in the community is associated with greater physical activity and reduced sedentary time among both boys and girls. All four types of activity contribute to overall physical activity, which provides parents with a range of settings in which to help their child be active. PMID:28912195

About the Community Oncology and Prevention Trials Research Group | Division of Cancer Prevention

Cancer.gov

The Community Oncology and Prevention Trials Research Group supports clinical oncology trials in cancer prevention and control in community settings. The group also supports investigator-initiated research projects in supportive, palliative and end-of-life care, and coordinates clinical oncology research projects with other NCI programs to be done in the community setting. |

Integrating cultural community psychology: activity settings and the shared meanings of intersubjectivity.

PubMed

O'Donnell, Clifford R; Tharp, Roland G

2012-03-01

Cultural and community psychology share a common emphasis on context, yet their leading journals rarely cite each other's articles. Greater integration of the concepts of culture and community within and across their disciplines would enrich and facilitate the viability of cultural community psychology. The contextual theory of activity settings is proposed as one means to integrate the concepts of culture and community in cultural community psychology. Through shared activities, participants develop common experiences that affect their psychological being, including their cognitions, emotions, and behavioral development. The psychological result of these experiences is intersubjectivity. Culture is defined as the shared meanings that people develop through their common historic, linguistic, social, economic, and political experiences. The shared meanings of culture arise through the intersubjectivity developed in activity settings. Cultural community psychology presents formidable epistemological challenges, but overcoming these challenges could contribute to the transformation and advancement of community psychology.

Indoglish as adaptation of english to Indonesian: change of society in big cities of Indonesia

NASA Astrophysics Data System (ADS)

Saddhono, K.; Sulaksono, D.

2018-03-01

Indoglish is a term that is often used for the use of Indonesian culture language nuances. Indoglish studies focus on the community, especially on the big cities in Indonesia. The use of language in society is chosen because the emerging form is the natural language, which in the context of linguistic research should actually be used in preference to describe large cities in Indonesia in actual language situations. The data of this study are various kinds of discourse obtained in the society, especially in five big cities in Indonesia where there is a form of linguistic language mixture of Indonesian and English. The main research data source is the community in big cities in Indonesia. The basic assumption for determining locational data sources is the consideration that people in large cities have diverse social, economic, and cultural backgrounds that are expected to reflect the condition of society. The major cities used as research sites are: (1) Jakarta, (2) Surakarta, (3) Surabaya, (4) Denpasar, and (5) Bandung. The data set used refers to the usual method of linguistic research. Data analysis is done by applying the usual method of distribution to linguistics. The method of analysis is performed after data is collected and classified and interpreted correctly. The results showed that in general the mastery of Indonesian language by the community was not good enough. Motivation to learn Indonesian in general is also not high enough in the community in big cities in Indonesia. With this background, then Indoglish emerged as a form of public utterance that occurs in the social. Indoglish also emerged as a form of community identity that has a prestigious sense if it smells of foreign cultural elements, including in it is the use of language.

Hospital and Community Characteristics Associated With Pediatric Direct Admission to Hospital.

PubMed

Leyenaar, JoAnna K; Shieh, Meng-Shiou; Lagu, Tara; Pekow, Penelope S; Lindenauer, Peter K

2017-10-27

One quarter of pediatric hospitalizations begin as direct admissions, defined as hospitalization without receiving care in the hospital's emergency department (ED). Direct admission rates are highly variable across hospitals, yet previous studies have not examined reasons for this variation. We aimed to determine the relationships between hospital and community factors and pediatric direct admission rates, and to evaluate the degree to which these characteristics explain variation in risk-adjusted direct admission rates. We conducted a cross-sectional study of the Healthcare Cost and Utilization Project's Kids Inpatient Database, American Hospital Association Database, and Area Health Resource File, including children <18 years of age who were admitted for a medical hospitalization in states contributing data to all data sets. Using hierarchical generalized linear modeling, we generated risk-adjusted direct admission rates and used generalized linear models to assess the association of hospital and community characteristics with these risk-adjusted rates. We included 211,458 children discharged from 933 hospitals and 26 states; 20.2% were admitted directly. One-fifth of the variance in risk-adjusted direct admission rates was attributed to observed hospital and community factors. The greatest proportion of this explained variance was related to ED volume (37%), volume of pediatric hospitalizations (27%), and size of the pediatrician workforce (12%). Direct admission rates were associated with several hospital and community characteristics, but the majority of variation in hospitals' direct admission rates was not explained by these factors. These findings suggest opportunities for diverse hospital types to develop the infrastructure and communication systems necessary to support pediatric direct admissions. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Origins Space Telescope: Science Case and Design Reference Mission for Concept 1

NASA Astrophysics Data System (ADS)

Meixner, Margaret; Cooray, Asantha; Pope, Alexandra; Armus, Lee; Vieira, Joaquin Daniel; Milam, Stefanie N.; Melnick, Gary; Leisawitz, David; Staguhn, Johannes G.; Bergin, Edwin; Origins Space Telescope Science and Technology Definition Team

2018-01-01

The Origins Space Telescope (OST) is the mission concept for the Far-Infrared Surveyor, one of the four science and technology definition studies of NASA Headquarters for the 2020 Astronomy and Astrophysics Decadal survey. The science case for OST covers four themes: Tracing the Signature of Life and the Ingredients of Habitable Worlds; Charting the Rise of Metals, Dust and the First Galaxies, Unraveling the Co-evolution of Black Holes and Galaxies and Understanding Our Solar System in the Context of Planetary System Formation. Using a set of proposed observing programs from the community, we estimate a design reference mission for OST mission concept 1. The mission will complete significant programs in these four themes and have time for other programs from the community. Origins will enable flagship-quality general observing programs led by the astronomical community in the 2030s. We welcome you to contact the Science and Technology Definition Team (STDT) with your science needs and ideas by emailing us at ost_info@lists.ipac.caltech.edu.

What should autism research focus upon? Community views and priorities from the United Kingdom

PubMed Central

Dinsmore, Adam; Charman, Tony

2014-01-01

The rise in the measured prevalence of autism has been accompanied by much new research and research investment internationally. This study sought to establish whether the pattern of current UK autism research funding maps on to the concerns of the autism community. Interviews and focus groups were conducted with autistic adults, family members, practitioners and researchers to identify their priorities for research. We also captured the views of a large number of stakeholders via an online survey. There was a clear disparity between the United Kingdom’s pattern of funding for autism research and the priorities articulated by the majority of participants. There was general consensus that future priorities for autism research should lie in those areas that make a difference to people’s day-to-day lives. There needs to be greater involvement of the autism community both in priority setting and in research more broadly to ensure that resources reach where they are most needed and can make the most impact. PMID:24789871

The family assessment device: an update.

PubMed

Mansfield, Abigail K; Keitner, Gabor I; Dealy, Jennifer

2015-03-01

The current study set out to describe family functioning scores of a contemporary community sample, using the Family Assessment Device (FAD), and to compare this to a currently help-seeking sample. The community sample consisted of 151 families who completed the FAD. The help-seeking sample consisted of 46 families who completed the FAD at their first family therapy appointment as part of their standard care at an outpatient family therapy clinic at an urban hospital. Findings suggest that FAD means from the contemporary community sample indicate satisfaction with family functioning, while FAD scores from the help-seeking sample indicate dissatisfaction with family functioning. In addition, the General Functioning scale of the FAD continues to correlate highly with all other FAD scales, except Behavior Control. The cut-off scores for the FAD indicating satisfaction or dissatisfaction by family members with their family functioning continue to be relevant and the FAD continues to be a useful tool to assess family functioning in both clinical and research contexts. © 2014 Family Process Institute.

Cytotoxic chemotherapy in the home: a study of community nurses' attitudes and concerns.

PubMed

Gavin, Noel; How, Chris; Condliffe, Barbara; Depledge, Jane

2004-01-01

Cytotoxic chemotherapy initiated in a hospital setting and continued in the home is an expanding service. The evolution of such a service received a boost with the publication of the NHS Cancer Plan (Department of Health (DH), 2000a) and the NHS Manual of Cancer Service Standards (DH, 2000b). The literature claims a range of benefits of such a service including enhanced standards of care and cost savings. Effective care depends on a number of key factors including assessment, management of risk and support, i.e. appropriate policies and the availability of adequate resources. This study among community nurses reveals a number of key findings including the incremental nature of the development of policy and practice, the general acceptance that changes in community practice are inevitable and welcome where the changes enhance the care of patients, and a level of concern about the availability of appropriate resources and structures necessary for safe and effective practice.

Mosaic Graphs and Comparative Genomics in Phage Communities

PubMed Central

Belcaid, Mahdi; Bergeron, Anne

2010-01-01

Abstract Comparing the genomes of two closely related viruses often produces mosaics where nearly identical sequences alternate with sequences that are unique to each genome. When several closely related genomes are compared, the unique sequences are likely to be shared with third genomes, leading to virus mosaic communities. Here we present comparative analysis of sets of Staphylococcus aureus phages that share large identical sequences with up to three other genomes, and with different partners along their genomes. We introduce mosaic graphs to represent these complex recombination events, and use them to illustrate the breath and depth of sequence sharing: some genomes are almost completely made up of shared sequences, while genomes that share very large identical sequences can adopt alternate functional modules. Mosaic graphs also allow us to identify breakpoints that could eventually be used for the construction of recombination networks. These findings have several implications on phage metagenomics assembly, on the horizontal gene transfer paradigm, and more generally on the understanding of the composition and evolutionary dynamics of virus communities. PMID:20874413

Four years of HELAS

NASA Astrophysics Data System (ADS)

Roth, M.; Lühe, O. v. d.; Aerts, C.; Christensen-Dalsgaard, J.; Corbard, T.; Daszyńska-Daszkiewicz, J.; Di Mauro, M. P.; Gizon, L.; Jiménez-Reyes, S.; Monteiro, M. J. P. F. G.; Pallé, P. L.; Thompson, M. J.

2010-12-01

The European Coordination Action on HELio- and ASteroseismology (HELAS) has completed its fourth and final year of initial funding by the European Commission. Set up as a network which combines solar and stellar physics communities in the important and vigorously evolving field of seismology, HELAS has been able to coordinate the efforts of European astronomers with remarkable success. Four large international conferences including the HELAS-IV conference on Lanzarote as well as many workshops were organized with a substantial contribution from HELAS. About a dozen workshops, addressing specialized questions in global and local helioseismology and asteroseismology were entirely organized by HELAS. Data analysis tools to prepare the European communities for the upcoming influx of data from new missions have been prepared, tested and demonstrated. Lecture notes and outreach material have been assembled and prepared for general access. As a result, HELAS has an important impact on the scientific output of the astrophysics seismology communities and significantly increased the visibility of European research in this field. This paper summarizes the activities and accomplishments of HELAS.

EURRECA: development of tools to improve the alignment of micronutrient recommendations.

PubMed

Matthys, C; Bucchini, L; Busstra, M C; Cavelaars, A E J M; Eleftheriou, P; Garcia-Alvarez, A; Fairweather-Tait, S; Gurinović, M; van Ommen, B; Contor, L

2010-11-01

Approaches through which reference values for micronutrients are derived, as well as the reference values themselves, vary considerably across countries. Harmonisation is needed to improve nutrition policy and public health strategies. The EURRECA (EURopean micronutrient RECommendations Aligned, http://www.eurreca.org) Network of Excellence is developing generic tools for systematically establishing and updating micronutrient reference values or recommendations. Different types of instruments (including best practice guidelines, interlinked web pages, online databases and decision trees) have been identified. The first set of instruments is for training purposes and includes mainly interactive digital learning materials. The second set of instruments comprises collection and interlinkage of diverse information sources that have widely varying contents and purposes. In general, these sources are collections of existing information. The purpose of the majority of these information sources is to provide guidance on best practice for use in a wider scientific community or for users and stakeholders of reference values. The third set of instruments includes decision trees and frameworks. The purpose of these tools is to guide non-scientists in decision making based on scientific evidence. This platform of instruments will, in particular in Central and Eastern European countries, contribute to future capacity-building development in nutrition. The use of these tools by the scientific community, the European Food Safety Authority, bodies responsible for setting national nutrient requirements and others should ultimately help to align nutrient-based recommendations across Europe. Therefore, EURRECA can contribute towards nutrition policy development and public health strategies.

Characteristics of good quality pharmaceutical services common to community pharmacies and dispensing general practices.

PubMed

Grey, Elisabeth; Harris, Michael; Rodham, Karen; Weiss, Marjorie C

2016-10-01

In the United Kingdom, pharmaceutical services can be delivered by both community pharmacies (CPs) and dispensing doctor practices (DPs). Both must adhere to minimum standards set out in NHS regulations; however, no common framework exists to guide quality improvement. Previous phases of this research had developed a set of characteristics indicative of good pharmaceutical service provision. To ask key stakeholders to confirm, and rank the importance of, a set of characteristics of good pharmaceutical service provision. A two-round Delphi-type survey was conducted in south-west England and was sent to participants representing three stakeholder groups: DPs, CPs and patients/lay members. Participants were asked to confirm, and rank, the importance of these characteristics as representing good quality pharmaceutical services. Thirty people were sent the first round survey; 22 participants completed both rounds. Median ratings for the 23 characteristics showed that all were seen to represent important aspects of pharmaceutical service provision. Participants' comments highlighted potential problems with the practicality of the characteristics. Characteristics relating to patient safety were deemed to be the most important and those relating to public health the least important. A set of 23 characteristics for providing good pharmaceutical services in CPs and DPs was developed and attained approval from a sample of stakeholders. With further testing and wider discussion, it is hoped that the characteristics will form the basis of a quality improvement tool for CPs and DPs. © 2016 Royal Pharmaceutical Society.

Feasibility, acceptability and diagnostic test accuracy of frailty screening instruments in community-dwelling older people within the Australian general practice setting: a study protocol for a cross-sectional study

PubMed Central

Visvanathan, Renuka; Cesari, Matteo; Yu, Solomon; Archibald, Mandy; Schultz, Timothy; Karnon, Jonathon; Kitson, Alison; Beilby, Justin

2017-01-01

Introduction Frailty is one of the most challenging aspects of population ageing due to its association with increased risk of poor health outcomes and quality of life. General practice provides an ideal setting for the prevention and management of frailty via the implementation of preventive measures such as early identification through screening. Methods and analysis Our study will evaluate the feasibility, acceptability and diagnostic test accuracy of several screening instruments in diagnosing frailty among community-dwelling Australians aged 75+ years who have recently made an appointment to see their general practitioner (GP). We will recruit 240 participants across 2 general practice sites within South Australia. We will invite eligible patients to participate and consent to the study via mail. Consenting participants will attend a screening appointment to undertake the index tests: 2 self-reported (Reported Edmonton Frail Scale and Kihon Checklist) and 5 (Frail Scale, Groningen Frailty Index, Program on Research for Integrating Services for the Maintenance of Autonomy (PRISMA-7), Edmonton Frail Scale and Gait Speed Test) administered by a practice nurse (a Registered Nurse working in general practice). We will randomise test order to reduce bias. Psychosocial measures will also be collected via questionnaire at the appointment. A blinded researcher will then administer two reference standards (the Frailty Phenotype and Adelaide Frailty Index). We will determine frailty by a cut-point of 3 of 5 criteria for the Phenotype and 9 of 42 items for the AFI. We will determine accuracy by analysis of sensitivity, specificity, predictive values and likelihood ratios. We will assess feasibility and acceptability by: 1) collecting data about the instruments prior to collection; 2) interviewing screeners after data collection; 3) conducting a pilot survey with a 10% sample of participants. Ethics and dissemination The Torrens University Higher Research Ethics Committee has approved this study. We will disseminate findings via publication in peer-reviewed journals and presentation at relevant conferences. PMID:28775191

[Community residential devices associated with Psychiatric Hospital "Dr. Manuel A. Montes De Oca" in the Province of Buenos Aires, Argentina].

PubMed

Keena, Cecilia; Rossetto, Jorge; Somoza, Matías; De Lellis, Martín

2017-01-01

The psychiatric hospital "Dr. Manuel A. Montes de Oca" has developed a Program for the Reform of the Model of Attention and Integral Rehabilitation that includes the implantation of community residential devices in the area of influence of the Institution. This program, which aims at the progressive replacement of asylum beds, has been the subject of an evaluative investigation that has included almost all the devices through a transversal and descriptive design, with instruments of survey created by the equipment and in agreement with the References of the Institution. The present article proposes to initiate a set of evaluative works in different dimensions concerning the institutional reform process, describing the antecedents, the objectives and the methodology and development of the study to achieve the general characterization of the devices. The main results of the study are summarized below on a set of aspects that we consider most signifcant for the characterization of the devices: a) Type of users served; B) Coverage of Care; C) Method of approach; D) Use of social and health services; E) Expenses and returns to the Institution; E) Main barriers encountered in the implementation of such devices. The work concludes with a series of proposals that are based on the survey carried out tending to promote the greatest possible sustainability in the implementation of the selected community devices.

Using ZIP Code Business Patterns Data to Measure Alcohol Outlet Density

PubMed Central

Matthews, Stephen A.; McCarthy, John D.; Rafail, Patrick S.

2014-01-01

Some states maintain high-quality alcohol outlet databases but quality varies by state, making comprehensive comparative analysis across US communities difficult. This study assesses the adequacy of using ZIP Code Business Patterns (ZIP-BP) data on establishments as estimates of the number of alcohol outlets by ZIP code. Specifically we compare ZIP-BP alcohol outlet counts with high-quality data from state and local records surrounding 44 college campus communities across 10 states plus the District of Columbia. Results show that a composite measure is strongly correlated (R=0.89) with counts of alcohol outlets generated from official state records. Analyses based on Generalized Estimation Equation models show that community and contextual factors have little impact on the concordance between the two data sources. There are also minimal inter-state differences in the level of agreement. To validate the use of a convenient secondary data set (ZIP-BP) it is important to have a high correlation with the more complex, high quality and more costly data product (i.e., datasets based on the acquisition and geocoding of state and local records) and then to clearly demonstrate that the discrepancy between the two to be unrelated to relevant explanatory variables. Thus our overall findings support the adequacy of using a conveniently available data set (ZIP-BP data) to estimate alcohol outlet densities in ZIP code areas in future research. PMID:21411233

Using ZIP code business patterns data to measure alcohol outlet density.

PubMed

Matthews, Stephen A; McCarthy, John D; Rafail, Patrick S

2011-07-01

Some states maintain high-quality alcohol outlet databases but quality varies by state, making comprehensive comparative analysis across US communities difficult. This study assesses the adequacy of using ZIP Code Business Patterns (ZIP-BP) data on establishments as estimates of the number of alcohol outlets by ZIP code. Specifically we compare ZIP-BP alcohol outlet counts with high-quality data from state and local records surrounding 44 college campus communities across 10 states plus the District of Columbia. Results show that a composite measure is strongly correlated (R=0.89) with counts of alcohol outlets generated from official state records. Analyses based on Generalized Estimation Equation models show that community and contextual factors have little impact on the concordance between the two data sources. There are also minimal inter-state differences in the level of agreement. To validate the use of a convenient secondary data set (ZIP-BP) it is important to have a high correlation with the more complex, high quality and more costly data product (i.e., datasets based on the acquisition and geocoding of state and local records) and then to clearly demonstrate that the discrepancy between the two to be unrelated to relevant explanatory variables. Thus our overall findings support the adequacy of using a conveniently available data set (ZIP-BP data) to estimate alcohol outlet densities in ZIP code areas in future research. Copyright © 2011 Elsevier Ltd. All rights reserved.

Evaluating the Implementation and Feasibility of a Web-Based Tool to Support Timely Identification and Care for the Frail Population in Primary Healthcare Settings.

PubMed

Lawson, Beverley; Sampalli, Tara; Wood, Stephanie; Warner, Grace; Moorhouse, Paige; Gibson, Rick; Mallery, Laurie; Burge, Fred; Bedford, Lisa G

2017-03-07

Understanding and addressing the needs of frail persons is an emerging health priority for Nova Scotia and internationally. Primary healthcare (PHC) providers regularly encounter frail persons in their daily clinical work. However, routine identification and measurement of frailty is not standard practice and, in general, there is a lack of awareness about how to identify and respond to frailty. A web-based tool called the Frailty Portal was developed to aid in identifying, screening, and providing care for frail patients in PHC settings. In this study, we will assess the implementation feasibility and impact of the Frailty Portal to: (1) support increased awareness of frailty among providers and patients, (2) identify the degree of frailty within individual patients, and (3) develop and deliver actions to respond to frailtyl in community PHC practice. This study will be approached using a convergent mixed method design where quantitative and qualitative data are collected concurrently, in this case, over a 9-month period, analyzed separately, and then merged to summarize, interpret and produce a more comprehensive understanding of the initiative's feasibility and scalability. Methods will be informed by the 'Implementing the Frailty Portal in Community Primary Care Practice' logic model and questions will be guided by domains and constructs from an implementation science framework, the Consolidated Framework for Implementation Research (CFIR). The 'Frailty Portal' aims to improve access to, and coordination of, primary care services for persons experiencing frailty. It also aims to increase primary care providers' ability to care for patients in the context of their frailty. Our goal is to help optimize care in the community by helping community providers gain the knowledge they may lack about frailty both in general and in their practice, support improved identification of frailty with the use of screening tools, offer evidence based severity-specific care goals and connect providers with local available community supports. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

New multidimensional functional diversity indices for a multifaceted framework in functional ecology.

PubMed

Villéger, Sébastien; Mason, Norman W H; Mouillot, David

2008-08-01

Functional diversity is increasingly identified as an important driver of ecosystem functioning. Various indices have been proposed to measure the functional diversity of a community, but there is still no consensus on which are most suitable. Indeed, none of the existing indices meets all the criteria required for general use. The main criteria are that they must be designed to deal with several traits, take into account abundances, and measure all the facets of functional diversity. Here we propose three indices to quantify each facet of functional diversity for a community with species distributed in a multidimensional functional space: functional richness (volume of the functional space occupied by the community), functional evenness (regularity of the distribution of abundance in this volume), and functional divergence (divergence in the distribution of abundance in this volume). Functional richness is estimated using the existing convex hull volume index. The new functional evenness index is based on the minimum spanning tree which links all the species in the multidimensional functional space. Then this new index quantifies the regularity with which species abundances are distributed along the spanning tree. Functional divergence is measured using a novel index which quantifies how species diverge in their distances (weighted by their abundance) from the center of gravity in the functional space. We show that none of the indices meets all the criteria required for a functional diversity index, but instead we show that the set of three complementary indices meets these criteria. Through simulations of artificial data sets, we demonstrate that functional divergence and functional evenness are independent of species richness and that the three functional diversity indices are independent of each other. Overall, our study suggests that decomposition of functional diversity into its three primary components provides a meaningful framework for its quantification and for the classification of existing functional diversity indices. This decomposition has the potential to shed light on the role of biodiversity on ecosystem functioning and on the influence of biotic and abiotic filters on the structure of species communities. Finally, we propose a general framework for applying these three functional diversity indices.

Community-wide assessment of pollen limitation in hummingbird-pollinated plants of a tropical montane rain forest

PubMed Central

Wolowski, Marina; Ashman, Tia-Lynn; Freitas, Leandro

2013-01-01

Background and Aims Although pollen limitation of reproduction (PL) has been widely studied, our understanding of its occurrence in tropical communities, especially for bird-pollinated plants, is underdeveloped. In addition, inclusion of both quantity and quality aspects in studies of PL are generally lacking. Within hummingbird-pollinated plants, a prediction was made for higher PL for the quality than quantity aspects and a minor effect of temporal variation because hummingbirds are constant and efficient pollen vectors but they may transfer low quality pollen. Methods Field hand and open pollination experiments were conducted on 21 species in a tropical montane rain forest over 2 years. The quantity (fruit set and seeds per fruit) and quality (seed weight and germination) aspects of reproduction were assessed as the response to open pollination relative to outcross hand pollination. The relationships between the effect size of quantity and quality aspects of reproduction and predictive plant features (self-incompatibility, autogamy, density and pollinator specialization level) were assessed with phylogenetic generalized linear models. Key Results Just over half of all the species expressed PL for one or more response variables. On average, the severity of PL was strong for one quality variable (seed germination; 0·83), but insignificant for another (seed weight; –0·03), and low to moderate for quantity variables (0·31 for seeds per fruit and 0·39 for fruit set). There was only a minor contribution of temporal variation to PL within the studied species. Common predictors of PL, i.e. phylogenetic relatedness, self-incompatibility, autogamy, plant density and pollinator specialization level, did not adequately explain variation in PL within this community. Conclusions Despite the measurable degree of PL within these hummingbird-pollinated plants, the causes of pollen quality and quantity insufficiency are not clear. Variables other than those tested may contribute to PL or causes of PL may vary among species and cannot adequately be accounted for when assessed from the within-community perspective. PMID:23845434

Risk assessment and HbA1c measurement in Norwegian community pharmacies to identify people with undiagnosed type 2 diabetes - A feasibility study.

PubMed

Risøy, Aslaug Johanne; Kjome, Reidun Lisbet Skeide; Sandberg, Sverre; Sølvik, Una Ørvim

2018-01-01

Determine the feasibility of using a diabetes risk assessment tool followed by HbA1c-measurement in a community-pharmacy setting in Norway. In this longitudinal study two pharmacists in each of three community pharmacies were trained to perform risk assessments, HbA1c-measurements and counselling. Pharmacy customers who were > 18 years old and could understand and speak Norwegian or English were recruited in the pharmacies during a two-months-period. Information about the service was presented in local newspapers, social media, leaflets and posters at the pharmacy. Customers wishing to participate contacted the pharmacy staff. Participants completed a validated diabetes risk test and a background questionnaire including a validated instrument for self-rated health. A HbA1c measurement was performed for individuals with a moderate to high risk of developing diabetes. If HbA1c ≥ 6.5% they were recommended to visit their general practitioner for follow-up. The pharmacies performed internal and external quality control of the HbA1c instrument. Of the 211 included participants 97 (46%) were > 50 years old. HbA1c was measured for the 47 participants (22%) with high risk. Thirty-two (15%) had HbA1c values < 5.7%, twelve (5.4%) had values between 5.7%-6.4%, and three (1.4%) had an HbA1c ≥ 6.5%. Two participants with HbA1 ≥ 6.5% were diagnosed with diabetes by their general practitioner. The third was lost to follow-up. Results from internal and external quality control for HbA1c were within set limits. The pharmacists were able to perform the risk assessment and measurement of HbA1c, and pharmacy customers were willing to participate. The HbA1c measurements fulfilled the requirements for analytical quality. Thus, it is feasible to implement this service in community pharmacies in Norway. In a large-scale study the inclusion criteria should be increased to 45 years in accordance with the population the risk test has been validated for.

Risk assessment and HbA1c measurement in Norwegian community pharmacies to identify people with undiagnosed type 2 diabetes – A feasibility study

PubMed Central

Kjome, Reidun Lisbet Skeide; Sandberg, Sverre; Sølvik, Una Ørvim

2018-01-01

Objectives Determine the feasibility of using a diabetes risk assessment tool followed by HbA1c-measurement in a community-pharmacy setting in Norway. Methods In this longitudinal study two pharmacists in each of three community pharmacies were trained to perform risk assessments, HbA1c-measurements and counselling. Pharmacy customers who were > 18 years old and could understand and speak Norwegian or English were recruited in the pharmacies during a two-months-period. Information about the service was presented in local newspapers, social media, leaflets and posters at the pharmacy. Customers wishing to participate contacted the pharmacy staff. Participants completed a validated diabetes risk test and a background questionnaire including a validated instrument for self-rated health. A HbA1c measurement was performed for individuals with a moderate to high risk of developing diabetes. If HbA1c ≥ 6.5% they were recommended to visit their general practitioner for follow-up. The pharmacies performed internal and external quality control of the HbA1c instrument. Results Of the 211 included participants 97 (46%) were > 50 years old. HbA1c was measured for the 47 participants (22%) with high risk. Thirty-two (15%) had HbA1c values < 5.7%, twelve (5.4%) had values between 5.7%—6.4%, and three (1.4%) had an HbA1c ≥ 6.5%. Two participants with HbA1 ≥ 6.5% were diagnosed with diabetes by their general practitioner. The third was lost to follow-up. Results from internal and external quality control for HbA1c were within set limits. Conclusion The pharmacists were able to perform the risk assessment and measurement of HbA1c, and pharmacy customers were willing to participate. The HbA1c measurements fulfilled the requirements for analytical quality. Thus, it is feasible to implement this service in community pharmacies in Norway. In a large-scale study the inclusion criteria should be increased to 45 years in accordance with the population the risk test has been validated for. PMID:29474501

A call for differentiated approaches to delivering HIV services to key populations.

PubMed

Macdonald, Virginia; Verster, Annette; Baggaley, Rachel

2017-07-21

Key populations (KPs) are disproportionally affected by HIV and have low rates of access to HIV testing and treatment services compared to the broader population. WHO promotes the use of differentiated approaches for reaching and recruiting KP into the HIV services continuum. These approaches may help increase access to KPs who are often criminalized or stigmatized. By catering to the specific needs of each KP individual, differentiated approaches may increase service acceptability, quality and coverage, reduce costs and support KP members in leading the HIV response among their communities. WHO recommends the implementation of community-based and lay provider administered HIV testing services. Together, these approaches reduce barriers and costs associated with other testing strategies, allow greater ownership in HIV programmes for KP members and reach more people than do facility-based services. Despite this evidence availability and support for them is limited. Peer-driven interventions have been shown to be effective in engaging, recruiting and supporting clients. Some programmes employ HIV-positive or non-PLHIV "peer navigators" and other staff to provide case management, enrolment and/or re-enrolment in care and treatment services. However, a better understanding of the impact, cost effectiveness and potential burden on peer volunteers is required. Task shifting and non-facility-based service locations for antiretroviral therapy (ART) initiation and maintenance and antiretroviral (ARV) distribution are recommended in both the consolidated HIV treatment and KP guidelines of WHO. These approaches are accepted in generalized epidemics and for the general population where successful models exist; however, few organizations provide or initiate ART at KP community-based services. The application of a differentiated service approach for KP could increase the number of people who know their status and receive effective and sustained prevention and treatment for HIV. However, while community-based and lay provider testing are effective and affordable, they are not implemented to scale. Furthermore regulatory barriers to legitimizing lay and peer providers as part of healthcare delivery systems need to be overcome in many settings. WHO recommendations on task shifting and decentralization of ART treatment and care are often not applied to KP settings.

Introducing consultant outpatient clinics to community settings to improve access to paediatrics: an observational impact study.

PubMed

McLeod, Hugh; Heath, Gemma; Cameron, Elaine; Debelle, Geoff; Cummins, Carole

2015-06-01

In line with a national policy to move care 'closer to home', a specialist children's hospital in the National Health Service in England introduced consultant-led 'satellite' clinics to two community settings for general paediatric outpatient services. Objectives were to reduce non-attendance at appointments by providing care in more accessible locations and to create new physical clinic capacity. This study evaluated these satellite clinics to inform further development and identify lessons for stakeholders. Impact of the satellite clinics was assessed by comparing community versus hospital-based clinics across the following measures: (1) non-attendance rates and associated factors (including patient characteristics and travel distance) using a logistic regression model; (2) percentage of appointments booked within local catchment area; (3) contribution to total clinic capacity; (4) time allocated to clinics and appointments; and (5) clinic efficiency, defined as the ratio of income to staff-related costs. Satellite clinics did not increase attendance beyond their contribution to shorter travel distance, which was associated with higher attendance. Children living in the most-deprived areas were 1.8 times more likely to miss appointments compared with those from least-deprived areas. The satellite clinics' contribution to activity in catchment areas and to total capacity was small. However, one of the two satellite clinics was efficient compared with most hospital-based clinics. Outpatient clinics were relocated in pragmatically chosen community settings using a 'drag and drop' service model. Such clinics have potential to improve access to specialist paediatric healthcare, but do not provide a panacea. Work is required to improve attendance as part of wider efforts to support vulnerable families. Satellite clinics highlight how improved management could contribute to better use of existing capacity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Engaging the Public to Identify Opportunities to Improve Critical Care: A Qualitative Analysis of an Open Community Forum

PubMed Central

Potestio, Melissa L.; Boyd, Jamie M.; Bagshaw, Sean M.; Heyland, Daren; Oxland, Peter; Doig, Christopher J.; Zygun, Dave; Stelfox, Henry T.

2015-01-01

Objective To engage the public to understand how to improve the care of critically ill patients. Design A qualitative content analysis of an open community forum (Café Scientifique). Setting Public venue in Calgary, Alberta, Canada. Participants Members of the general public including patients, families of patients, health care providers, and members of the community at large. Methods A panel of researchers, decision-makers, and a family member led a Café Scientifique, an informal dialogue between the populace and experts, over three-hours to engage the public to understand how to improve the care of critically ill patients. Conventional qualitative content analysis was used to analyze the data. The inductive analysis occurred in three phases: coding, categorizing, and developing themes. Results Thirty-eight members of the public (former ICU patients, family members of patients, providers, community members) attended. Participants focused the discussion and provided concrete suggestions for improvement around communication (family as surrogate voice, timing of conversations, decision tools) and provider well-being and engagement, as opposed to medical interventions in critical care. Conclusions Café participants believe patient and family centered care is important to ensure high-quality care in the ICU. A Café Scientifique is a valuable forum to engage the public to contribute to priority setting areas for research in critical care, as well as a platform to share lived experience. Research stakeholders including health care organizations, governments, and funding organizations should provide more opportunities for the public to engage in meaningful conversations about how to best improve healthcare. PMID:26580406

Universality of human microbial dynamics

NASA Astrophysics Data System (ADS)

Bashan, Amir; Gibson, Travis E.; Friedman, Jonathan; Carey, Vincent J.; Weiss, Scott T.; Hohmann, Elizabeth L.; Liu, Yang-Yu

2016-06-01

Human-associated microbial communities have a crucial role in determining our health and well-being, and this has led to the continuing development of microbiome-based therapies such as faecal microbiota transplantation. These microbial communities are very complex, dynamic and highly personalized ecosystems, exhibiting a high degree of inter-individual variability in both species assemblages and abundance profiles. It is not known whether the underlying ecological dynamics of these communities, which can be parameterized by growth rates, and intra- and inter-species interactions in population dynamics models, are largely host-independent (that is, universal) or host-specific. If the inter-individual variability reflects host-specific dynamics due to differences in host lifestyle, physiology or genetics, then generic microbiome manipulations may have unintended consequences, rendering them ineffective or even detrimental. Alternatively, microbial ecosystems of different subjects may exhibit universal dynamics, with the inter-individual variability mainly originating from differences in the sets of colonizing species. Here we develop a new computational method to characterize human microbial dynamics. By applying this method to cross-sectional data from two large-scale metagenomic studies—the Human Microbiome Project and the Student Microbiome Project—we show that gut and mouth microbiomes display pronounced universal dynamics, whereas communities associated with certain skin sites are probably shaped by differences in the host environment. Notably, the universality of gut microbial dynamics is not observed in subjects with recurrent Clostridium difficile infection but is observed in the same set of subjects after faecal microbiota transplantation. These results fundamentally improve our understanding of the processes that shape human microbial ecosystems, and pave the way to designing general microbiome-based therapies.

A snapshot of pharmacist attitudes and behaviors surrounding the management of pediatric asthma.

PubMed

Elaro, Amanda; Shah, Smita; Armour, Carol L; Bosnic-Anticevich, Sinthia

2015-01-01

The aim of this study is to identify the current status of pediatric asthma management in the Australian community pharmacy setting from the pharmacists' perspective. This research will allow us to identify training needs of community pharmacists. Pharmacists were recruited from the Sydney metropolitan region and asked to complete a self-reported questionnaire that elucidated information on four general domains relating to pediatric asthma management within community pharmacy. All data collected were analysed descriptively. Bivariate Pearson correlations were performed to determine whether interrelationships existed between specific domains. All 77 pharmacists completed the questionnaire. Thirty-two percent had not completed any asthma related CPD in the past year and only 25% of pharmacists reported using the national asthma guidelines in practice. Just over half of the pharmacists (54%) reported that they provide device technique demonstrations for new inhaled medicines, and 35% of pharmacists reported that they check for written asthma self-management plan possession. Although 65% of pharmacists reported confidence in communication skills, most pharmacists were not confident in setting short-/long-term goals with the patient and carer for managing asthma at home. Pharmacists believed that they are just as effective as doctors in providing asthma counseling and education. Lack of time was identified as a significant barrier. We have identified a gap between guideline recommended practices and the self-reported practices of community pharmacists. Pharmacists need more appropriate continuing education programs that can translate into improved pediatric asthma self-management practices and thus improved asthma outcomes in children. This may require an alternative approach.

Using Analysis of Governance to Unpack Community-Based Conservation: A Case Study from Tanzania.

PubMed

Robinson, Lance W; Makupa, Enock

2015-11-01

Community-based conservation policies and programs are often hollow with little real devolution. But to pass a judgment of community-based or not community-based on such initiatives and programs obscures what is actually a suite of attributes. In this paper, we analyze governance around a specific case of what is nominally community-based conservation-Ikona Wildlife Management Area (WMA) in Tanzania-using two complementary sets of criteria. The first relates to governance "powers": planning powers, regulatory powers, spending powers, revenue-generating powers, and the power to enter into agreements. The second set of criteria derive from the understanding of governance as a set of social functions: social coordination, shaping power, setting direction, and building community. The analysis helps to detail ways in which the Tanzanian state through policy and regulations has constrained the potential for Ikona WMA to empower communities and community actors. Although it has some features of community-based conservation, community input into how the governance social functions would be carried out in the WMA was constrained from the start and is now largely out of community hands. The two governance powers that have any significant community-based flavor-spending powers and revenue-generating powers-relate to the WMA's tourism activities, but even here the picture is equivocal at best. The unpacking of governance that we have done, however, reveals that community empowerment through the processes associated with creating and recognizing indigenous and community-conserved areas is something that can be pursued through multiple channels, some of which might be more strategic than others.

Creativity and power: a qualitative, exploratory study of student learning acquired in a community nursing setting that is applied in future settings.

PubMed

Merritt, Alan; Boogaerts, Marina

2014-01-01

Nursing students undertake clinical placements in a wide range of clinical areas as part of their preparation for professional practice, offering students the opportunity to learn about the clinical context and the work that nurses do. This descriptive study explores the implicit learnings that occur for students in a community nursing placement and whether they transfer the knowledge they gain in the community setting into practice in other settings. Participants in this research study described implicit learning from a community nursing context which they were able to utilise in their current practice. Three major themes emerged. Firstly, participants recognised that power relationships manifest differently in a community based setting. This manifest in a recognition of patient autonomy and a creative approach to enhancing the patient's power. The second, related theme involved the enabling of self-determination through collaborative decision making between nurse and the person receiving care. The third theme was the development of an understanding of self-management which manifest in appropriate referrals and what the participants considered high quality discharge planning. This recognition of practice beyond technical, rationalist manifestations suggests that students grasped the unarticulated, implicit dimensions of the community nurse role through their experiences in a community nursing placement.

Community-partnered evaluation of depression services for clients of community-based agencies in under-resourced communities in Los Angeles.

PubMed

Miranda, Jeanne; Ong, Michael K; Jones, Loretta; Chung, Bowen; Dixon, Elizabeth L; Tang, Lingqi; Gilmore, Jim; Sherbourne, Cathy; Ngo, Victoria K; Stockdale, Susan; Ramos, Esmeralda; Belin, Thomas R; Wells, Kenneth B

2013-10-01

As medical homes are developing under health reform, little is known regarding depression services need and use by diverse safety-net populations in under-resourced communities. For chronic conditions like depression, primary care services may face new opportunities to partner with diverse community service providers, such as those in social service and substance abuse centers, to support a collaborative care model of treating depression. To understand the distribution of need and current burden of services for depression in under-resourced, diverse communities in Los Angeles. Baseline phase of a participatory trial to improve depression services with data from client screening and follow-up surveys. Of 4,440 clients screened from 93 programs (primary care, mental health, substance abuse, homeless, social and other community services) in 50 agencies, 1,322 were depressed according to an eight-item Patient Health Questionnaire (PHQ-8) and gave contact information; 1,246 enrolled and 981 completed surveys. Ninety-three programs, including 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services, participated. Comparisons by setting in 6-month retrospective recall of depression services use. Depression prevalence ranged from 51.9 % in mental health to 17.2 % in social-community programs. Depressed clients used two settings on average to receive depression services; 82 % used any setting. More clients preferred counseling over medication for depression treatment. Need for depression care was high, and a broad range of agencies provide depression care. Although most participants had contact with primary care, most depression services occurred outside of primary care settings, emphasizing the need to coordinate and support the quality of community-based services across diverse community settings.

The effectiveness of community-based loan funds for transport during obstetric emergencies in developing countries: a systematic review.

PubMed

Nwolise, Chidiebere Hope; Hussein, Julia; Kanguru, Lovney; Bell, Jacqueline; Patel, Purvi

2015-09-01

Scarcity and costs of transport have been implicated as key barriers to accessing care when obstetric emergencies occur in community settings. Community-based loans have been used to increase utilization of health facilities and potentially reduce maternal mortality by providing funding at community level to provide emergency transport. This review aimed to provide evidence of the effect of community-based loan funds on utilization of health facilities and reduction of maternal mortality in developing countries. Electronic databases of published literature and websites were searched for relevant literature using a pre-defined set of search terms, inclusion and exclusion criteria. Screening of titles, abstracts and full-text articles were done by at least two reviewers independently. Quality assessment was carried out on the selected papers. Data related to deliveries and obstetric complications attended at facilities, maternal deaths and live births were extracted to measure and compare the effects of community-based loan funds using odds ratios (ORs) and reductions in maternal mortality ratio. Forest plots are presented where possible. The results of the review show that groups where community-based loan funds were implemented (alongside other interventions) generally recorded increases in utilization of health facilities for deliveries, with ORs of 3.5 (0.97-15.48) and 3.55 (1.56-8.05); and an increase in utilization of emergency obstetric care with ORs of 2.22 (0.51-10.38) and 3.37 (1.78-6.37). Intervention groups also experienced a positive effect on met need for complications and a reduction in maternal mortality. There is some evidence to suggest that community-based loan funds as part of a multifaceted intervention have positive effects. Conclusions are limited by challenges of study design and bias. Further studies which strengthen the evidence of the effects of loan funds, and mechanism for their functionality, are recommended. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Community College General Academic Course Guide Manual.

ERIC Educational Resources Information Center

Texas Higher Education Coordinating Board, Austin. Div. of Community and Technical Colleges.

The Community College General Academic Course Guide Manual (ACGM) is the official list of approved numbers for general academic transfer courses that may be offered by public community and technical colleges in Texas for state funding. This edition of the ACGM, effective September 1996, contains the latest information available for academic…

Common Data Format: New XML and Conversion Tools

NASA Astrophysics Data System (ADS)

Han, D. B.; Liu, M. H.; McGuire, R. E.

2002-12-01

Common Data Format (CDF) is a self-describing platform-independent data format for storing, accessing, and manipulating scalar and multidimensional scientific data sets. Significant benefit has accrued to specific science communities from their use of standard formats within those communities. Examples include the International Solar Terrestrial Physics (ISTP) community in using CDF for traditional space physics data (fields, particles and plasma, waves, and images), the worldwide astronomical community in using FITS (Flexible Image Transport System) for solar data (primarily spectral images), the NASA Planetary community in using Planetary Data System (PDS) Labels, and the earth science community in using Hierarchical Data Format (HDF). Scientific progress in solar-terrestrial physics continues to be impeded by the multiplicity of available standards for data formats and dearth of general data format translators. As a result, scientists today spend a significant amount of time translating data into the format they are familiar with for their research. To minimize this unnecessary data translation time and to allow more research time, the CDF office located at GSFC National Space Science Data Center (NSSDC) has developed HDF-to-CDF and FITS-to-CDF translators, and employed the eXtensible Markup Language (XML) technology to facilitate and promote data interoperability within the space science community. We will present the current status of the CDF work including the conversion tools that have been recently developed, conversion tools that are planned in the near future, share some of the XML experiences, and use the discussion to gain community feedback to our planned future work.

The work-based predictors of job engagement and job satisfaction experienced by community health professionals.

PubMed

Noblet, Andrew J; Allisey, Amanda F; Nielsen, Ingrid L; Cotton, Stacey; LaMontagne, Anthony D; Page, Kathryn M

Job engagement represents a critical resource for community-based health care agencies to achieve high levels of effectiveness. However, studies examining the organizational sources of job engagement among health care professionals have generally overlooked those workers based in community settings. This study drew on the demand-control model, in addition to stressors that are more specific to community health services (e.g., unrewarding management practices), to identify conditions that are closely associated with the engagement experienced by a community health workforce. Job satisfaction was also included as a way of assessing how the predictors of job engagement differ from those associated with other job attitudes. Health and allied health care professionals (n = 516) from two Australian community health services took part in the current investigation. Responses from the two organizations were pooled and analyzed using linear multiple regression. The analyses revealed that three working conditions were predictive of both job engagement and job satisfaction (i.e., job control, quantitative demands, and unrewarding management practices). There was some evidence of differential effects with cognitive demands being associated with job engagement, but not job satisfaction. The results provide important insights into the working conditions that, if addressed, could play key roles in building a more engaged and satisfied community health workforce. Furthermore, working conditions like job control and management practices are amenable to change and thus represent important areas where community health services could enhance the energetic and motivational resources of their employees.

Enhancing undergraduate community placements: a critical review of current literature.

PubMed

Dickson, Caroline A W; Morris, Gillian; Gable, Clare

2015-04-01

In the face of the UK-wide policy shift to increased home care, inspiring and enabling the next generation of community nurses is more urgent than ever. The quality of the pre-registration practice learning experience is highly influential on career choices at the point of qualification. Given that 50% of learning by pre-registration students takes place in practice, mentors have a crucial role to play in preparing the next generation of nurses to work in the community. This article discusses the findings of a systematic and critical literature review of pre-registration placements that was funded by the Queen's Nursing Institute Scotland. The review found that students' experiences of learning in community settings are variable, and perceptions of students and mentors are misaligned in terms of what a quality placement should look like. Although there is no clear definition of what constitutes a community placement and there is some underuse of learning environments in areas such as general practice nursing, there are also a number of examples of new and imaginative placements. While these innovations provide 'whole experience' placements, they are currently lacking robust evaluation, despite their potential usefulness on a larger scale. Mentors have the opportunity to provide students with a range of learning opportunities that increase preparedness for working in the community, allowing final year students in particular greater influence over their learning experience. Students undertaking community practice learning, where they have a managed level of autonomy, are more likely to feel confident to take on community nursing roles.

Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics.

PubMed

Wirtz, Andrea L; Pretorius, Carel; Beyrer, Chris; Baral, Stefan; Decker, Michele R; Sherman, Susan G; Sweat, Michael; Poteat, Tonia; Butler, Jennifer; Oelrichs, Robert; Semini, Iris; Kerrigan, Deanna

2014-01-01

Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented. We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5-65% in Kenya and Ukraine; 10-70% in Thailand and Brazil), while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012-2016 and, compared to status quo when all interventions are held constant. Optimistic but feasible coverage (65%-70%) of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size. A community empowerment approach to HIV prevention and access to universal ART for female sex workers is a promising human rights-based solution to overcoming the persistent burden of HIV among female sex workers across epidemic settings.

Fifty year canon of solar eclipses: 1986-2035

NASA Technical Reports Server (NTRS)

Espenak, Fred

1986-01-01

A reference of moderately detailed eclipse predictions and maps for use by the professional astronomical community is provided. The general characteristics of every solar eclipse and a detailed set of cylindrical project world maps which show the umbral paths of every solar eclipse from 1901 to 2100 are presented. The geodetic path coordinates and local circumstance on the center line, and a series of orthographic projection maps which show the regions of visibility of both partial and central phases for every eclipse from 1986 through 2035 are also provided.

Life Support Baseline Values and Assumptions Document

NASA Technical Reports Server (NTRS)

Anderson, Molly S.; Ewert, Michael K.; Keener, John F.

2018-01-01

The Baseline Values and Assumptions Document (BVAD) provides analysts, modelers, and other life support researchers with a common set of values and assumptions which can be used as a baseline in their studies. This baseline, in turn, provides a common point of origin from which many studies in the community may depart, making research results easier to compare and providing researchers with reasonable values to assume for areas outside their experience. This document identifies many specific physical quantities that define life support systems, serving as a general reference for spacecraft life support system technology developers.

Use of text messaging to audit early clinical outcome following vasectomy in primary care.

PubMed

Cooper, Graham; Walker, Jean; Harris, Douglas; Stewart, Rorie; Nicol, Douglas; Ogg, Mike

2011-04-01

Fifty patients undergoing vasectomy at community-based day surgery clinics in Grampian were invited to participate in follow-up by text message. Forty-six (92%) of the patients responded, 14 reporting problems, generally of a minor nature, but severe enough to result in unscheduled time off work (n = 4) and oral antibiotic therapy (n = 5). Text messaging appears to be a useful form of communication for audit in this setting. The study findings have influenced the information provided by the authors at preoperative counselling.

IGS Data Flow

NASA Technical Reports Server (NTRS)

Noll, Carey

2006-01-01

The IGS analysis centers and user community in general need to be assured that the data centers archive a consistent set of files. Changes to the archives can occur because of the re-publishing of data, the transmission of historic data, and the resulting re-distribution (or lack thereof) of these data from data center to data center. To ensure the quality of the archives, a defined data flow and method of archive population needs to be established. This poster will diagram and review the current IGS data flow, discuss problems that have occurred, and provide recommendations for improvement.

An evidence-based approach to the prevention and initial management of skin tears within the aged community setting: a best practice implementation project.

PubMed

Beechey, Rebekah; Priest, Laura; Peters, Micah; Moloney, Clint

2015-06-12

Maintaining skin integrity in a community setting is an ongoing issue, as research suggests that the prevalence of skin tears within the community is greater than that in an institutional setting. While skin tear prevention and management principles in these settings are similar to those in an acute care setting, consideration of the environmental and psychological factors of the client is pivotal to prevention in a community setting. Evidence suggests that home environment assessment, education for clients and care givers, and being proactive in improving activities of daily living in a community setting can significantly reduce the risk of sustaining skin tears. The aim of this implementation project was to assess and review current skin tear prevention and management practices within the community setting, and from this, to implement an evidence-based approach in the education of clients and staff on the prevention of skin tears. As well. the project aims to implement evidence-based principles to guide clinical practice in relation to the initial management of skin tears, and to determine strategies to overcome barriers and non-compliance. The project utilized the Joanna Brigg's Institute Practical Application of Clinical Evidence System audit tool for promoting changes in the community health setting. The implementation of this particular project is based in a region within Anglicare Southern Queensland. A small team was established and a baseline audit carried out. From this, multiple strategies were implemented to address non-compliance which included education resources for clients and caregivers, staff education sessions, and creating skin integrity kits to enable staff members to tend to skin tears, and from this a follow-up audit undertaken. Baseline audit results were slightly varied, from good to low compliance. From this, the need for staff and client education was highlighted. There were many improvements in the audit criteria following client and staff education sessions and staff self-directed learning packages. Future strategies required to sustain improvements in practice and make further progress are to introduce a readily available Anglicare Skin Integrity Assessment Tool to the nursing staff for undertaking new client admissions over 65 years, and to provide ongoing education to staff members, clients and care givers in order to reduce the prevalence of skin tears in the community setting. This implementation project demonstrated the importance of education of personal care workers, clients and their caregivers for prevention of skin tears in the community setting. This in turn created autonomy and empowered clients to take control of their health. The Joanna Briggs Institute.

Freshwater scarcity effects on the aquatic macrofauna of a European Mediterranean-climate estuary.

PubMed

González-Ortegón, Enrique; Baldó, Francisco; Arias, Alberto; Cuesta, Jose A; Fernández-Delgado, Carlos; Vilas, César; Drake, Pilar

2015-01-15

In the Mediterranean-climate zone, recurrent drought events and increasing water demand generally lead to a decrease in freshwater input to estuaries. This water scarcity may alter the proper function of estuaries as nursery areas for marine species and as permanent habitat for estuarine species. A 12-year data set of the aquatic macrofauna (fish, decapod and mysid crustaceans) in a Mediterranean estuary (Guadalquivir estuary, South Spain) was analysed to test if water scarcity favours the nursery function of regional estuaries to the detriment of permanent estuarine inhabitants. Target species typically displayed a salinity-related distribution and estuarine salinisation in dry years resulted in a general upstream community displacement. However, annual densities of marine species were neither consistently higher in dry years nor estuarine species during wet years. Exceptions included the estuarine mysid Neomysis integer and the marine shrimp Crangon crangon, which were more abundant in wet and dry years, respectively. High and persistent turbidity, a collateral effect of water scarcity, altered both the structural (salinity-related pattern) and functional (key prey species and predator density) community characteristics, chiefly after the second drought period of the analysis. The observed high inter-year environmental variability, as well as species-specific effects of water scarcity, suggests that exhaustive and long-term sampling programmes will be required for rigorously monitoring the estuarine communities of the Mediterranean-climate region. Copyright © 2014 Elsevier B.V. All rights reserved.

A Generalized Spatial Measure for Resilience of Microbial Systems

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

Renslow, Ryan S.; Lindemann, Stephen R.; Song, Hyun-Seob

2016-04-07

The emergent property of resilience is the ability of a system to return to an original state after a disturbance. Resilience may be used as an early warning system for significant or irreversible community transition, i.e., a community with diminishing or low resilience may be close to catastrophic shift in function or an irreversible collapse. Typically, resilience is quantified using recovery time, which may be difficult or impossible to directly measure in microbial systems. A recent study in the literature showed that under certain conditions, a set of spatial-based metrics termed recovery length, can be correlated to recovery time, andmore » thus may be a reasonable alternative measure of resilience. As a limitation, however, this spatial metric of resilience is useful only for step-change perturbations. Building upon the concept of recovery length, we propose a more general form of the spatial metric of resilience that can be applied to any shape of perturbation profiles (i.e., a sharp or smooth gradient). We termed this new spatial measure “perturbation-adjusted spatial metric of resilience” (PASMORE). We demonstrate the applicability of the proposed metric using a mathematical model of a microbial mat. PASMORE can help identify when a system, such as a microbial community, is on the verge of collapse or nearing an irreversible transition across a tipping point.« less

Prevalence, associated factors and predictors of anxiety: a community survey in Selangor, Malaysia.

PubMed

Kader Maideen, Siti Fatimah; Mohd Sidik, Sherina; Rampal, Lekhraj; Mukhtar, Firdaus

2015-10-24

Anxiety is the most common mental health disorders in the general population. This study aimed to determine the prevalence of anxiety, its associated factors and the predictors of anxiety among adults in the community of Selangor, Malaysia. A cross sectional study was carried out in three districts in Selangor, Malaysia. The inclusion criteria of this study were Malaysian citizens, adults aged 18 years and above, and living in the selected living quarters based on the list provided by the Department of Statistics Malaysia (DOS). Participants completed a set of questionnaires, including the validated Malay version of Generalized Anxiety Disorder 7 (GAD 7) to detect anxiety. Of the 2512 participants who were approached, 1556 of them participated in the study (61.90%). Based on the cut-off point of 8 and above in the GAD-7, the prevalence of anxiety was 8.2%. Based on the initial multiple logistic regression analysis, the predictors of anxiety were depression, serious problems at work, domestic violence and high perceived stress. When reanalyzed again after removing depression, low self-esteem and high perceived stress, six predictors that were identified are cancer, serious problems at work, domestic violence, unhappy relationship with family, non-organizational religious activity and intrinsic religiosity. This study reports the prevalence of anxiety among adults in the community of Selangor, Malaysia and also the magnitude of the associations between various factors and anxiety.

Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

PubMed

van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Vissers, Kris C; Deliens, Luc; Jansen, Wim J J; Francke, Anneke L

2016-01-01

To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. Cross-sectional questionnaire study. Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011-December 2013. Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses. © 2015 John Wiley & Sons Ltd.

Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey.

PubMed

Scobbie, Lesley; Duncan, Edward A; Brady, Marian C; Wyke, Sally

2015-01-01

We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n = 335/407) and provided input to a mixed diagnostic group of patients (71%; n = 312/437). Ninety one percent of services (n = 358/395) reported setting goals with "all" or "most" stroke survivors. Seventeen percent (n = 65/380) reported that no methods were used to guide goal setting practice; 47% (n = 148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n = 362/369) reported routinely asking patients about goal priorities; 39% (n = 141/360) reported routinely providing patients with a copy of their goals. Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist. Implications for Rehabilitation Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients. Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal. Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.

The reliability and utility of spirometry performed on people with asthma in community pharmacies.

PubMed

Lei Burton, Deborah; LeMay, Kate S; Saini, Bandana; Smith, Lorraine; Bosnic-Anticevich, Sinthia; Southwell, Phillipa; Cooke, Julie; Emmerton, Lynne; Stewart, Kay; Krass, Ines; Reddel, Helen; Armour, Carol

2015-01-01

To investigate the reliability and the utility of spirometry generated by community pharmacists participating in two large asthma intervention trials of 892 people. The Pharmacy Asthma Care Program (PACP) and the Pharmacy Asthma Management Service (PAMS) involved up to four visits to the pharmacy over 6 months for counseling and goal setting. Pharmacists performed spirometry according to ATS/ERS guidelines to inform management. The proportion of A-E, F quality tests, as per EasyOne QC grades, were recorded. Lung function results between visits and for participants referred/not referred to their general practitioner on the basis of spirometry were compared. Complete data from 2593 spirometry sessions were recorded, 68.5% of spirometry sessions achieved three acceptable tests with between-test repeatability of 150 ml or less (A or B quality), 96% of spirometry sessions included at least one test that met ATS/ERS acceptability criteria. About 39.1% of participants had FEV1/FVC values below the lower limit of normal (LNN), indicating a respiratory obstruction. As a result of the service, there was a significant increase in FEV1 and FEV1/FVC and asthma control. Lung function values were significantly poorer for participants referred to their general practitioner, compared with those not referred, on the basis of spirometry. Community pharmacists are able to reliably achieve spirometry results meeting ATS/ERS guidelines in people with asthma. Significant improvements in airway obstruction were demonstrated with the pharmacy services. Pharmacists interpreted lung function results to identify airway obstruction for referral, making this a useful technique for review of people with asthma in the community.

A Brief History of General Education

ERIC Educational Resources Information Center

O'Banion, Terry

2016-01-01

In the 1960s, general education was at the forefront of innovative programs in American community colleges. Every community college designed a program of a common core of courses for the common person. General education was so popular it was included as one of the required components of a comprehensive community college along with university…

Mobilization for cervical cancer screening: lessons from a poor-urban Yoruba community in Nigeria.

PubMed

Thomas, J O; Babarinsa, I A; Ajayi, I O; Fawole, O; Ojemakinde, K O; Omigbodun, A O

2005-03-01

Cervical cancer is a major public health problem worldwide and it remains one of the commonest malignancies in Nigeria. Screening remains the most effective tool for the detection of pre-invasive stages of cervical cancer, giving the opportunity for prompt and effective treatment before the emergence of invasive disease. In Nigeria, as in most developing countries, the concept of screening for cancer and its pre-emptive treatment is underdeveloped. The fact that the facilities and logistics for cervical cancer screening are generally located in the hospital setting, a place where one goes when ill, according to local beliefs, makes acceptance more difficult. That Nigeria urgently needs to set up or develop cervical screening programmes that will reach women outside the hospital setting in a culturally acceptable milieu is not in doubt. A community cervical screening survey for the prevalence of cervical intraepithelial neoplasia and HPV infection was initiated in Idikan, a poor-urban inner core area of Ibadan. The challenges and experiences encountered in the execution of the project which could serve as useful knowledge to those undertaking similar exercises, requiring mass mobilization for cancer screening of an uninformed group, are highlighted. Our experience in the course of this study is important as it brought out the probable influences of community dynamics and social organization in illness decisions and prescriptions for health operative in this particular population group. Cervical cancer screening programmes should therefore make provisions to accommodate the occasional outcomes as we had encountered. In addition, screening programmes in developing societies would require sensitive designs that should address the cultural attitudes, personal conflicts, expectations of treatment and overall context of preventive care.

Community pharmacists' perceptions of services that benefit older people in New Zealand.

PubMed

Tordoff, June; Chang, Shih Yen; Norris, Pauline T

2012-04-01

There is limited information in New Zealand about community pharmacists' perceptions of services that benefit older people. To explore the perceptions of community pharmacists' of services that benefit older people; the benefits perceived; and the experiences of pharmacists providing such services. Community pharmacies in New Zealand. A cross-sectional purpose-developed survey was carried out of all community pharmacies in New Zealand. This was followed by twenty qualitative telephone interviews of pharmacists identified as providing at least one specialized service. Interviews were recorded, transcribed verbatim, and coded for themes using constant comparison. Community pharmacists' opinions and perceptions in the cross-sectional survey and qualitative interviews. Responses were received from pharmacists in 403/905 evaluable pharmacies. All pharmacies provided some baseline services (advice, dispensing of prescriptions, medicines disposal) and 90% provided home deliveries of medicines. Adherence to medicines was supported by compliance packaging (96%), medication review (Medicines Use Review, MUR) (28%), and repeat prescription reminders (27%). Thirty-five percent provided screening (e.g. cholesterol, blood pressure), and 32% provided medicines education to community groups. Compliance packaging and home delivery were thought the services most beneficial for older people, and should help people adhere to their medicines. The 20 pharmacists interviewed by telephone provided 20 different specialized services (median 2, range 1-4). These included MUR, services to residential homes, visiting educators/special clinics, INR monitoring, services to hospices, and flu vaccination. Benefits perceived included improvements in adherence, patient safety, and patient-knowledge of medicines, and convenient access to services. "Patient need" was a frequent driver of services, and common facilitators for services were having appropriate training/skills, co-operation with health professionals, peer or expert support, sufficient time and funding. A lack of these facilitators were considered barriers as were resistance from general practitioners or the general public, or high set-up costs. Community pharmacists in New Zealand perceived they provide a range of services of potential benefit to older people for managing their medicines. Establishing new services requires cooperation from other health professionals, peer support, training, funding and time. Further research into patients' outcomes from new and established services is needed.

Differing Strategies to Meet Information‐Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems’ Enterprise Health Information Exchanges

PubMed Central

KASH, BITA A.

2016-01-01

Policy Points: Community health information exchanges have the characteristics of a public good, and they support population health initiatives at the state and national levels. However, current policy equally incentivizes health systems to create their own information exchanges covering more narrowly defined populations.Noninteroperable electronic health records and vendors’ expensive custom interfaces are hindering health information exchanges. Moreover, vendors are imposing the costs of interoperability on health systems and community health information exchanges.Health systems are creating networks of targeted physicians and facilities by funding connections to their own enterprise health information exchanges. These private networks may change referral patterns and foster more integration with outpatient providers. Context The United States has invested billions of dollars to encourage the adoption of and implement the information technologies necessary for health information exchange (HIE), enabling providers to efficiently and effectively share patient information with other providers. Health care providers now have multiple options for obtaining and sharing patient information. Community HIEs facilitate information sharing for a broad group of providers within a region. Enterprise HIEs are operated by health systems and share information among affiliated hospitals and providers. We sought to identify why hospitals and health systems choose either to participate in community HIEs or to establish enterprise HIEs. Methods We conducted semistructured interviews with 40 policymakers, community and enterprise HIE leaders, and health care executives from 19 different organizations. Our qualitative analysis used a general inductive and comparative approach to identify factors influencing participation in, and the success of, each approach to HIE. Findings Enterprise HIEs support health systems' strategic goals through the control of an information technology network consisting of desired trading partners. Community HIEs support obtaining patient information from the broadest set of providers, but with more dispersed benefits to all participants, the community, and patients. Although not an either/or decision, community and enterprise HIEs compete for finite organizational resources like time, skilled staff, and money. Both approaches face challenges due to vendor costs and less‐than‐interoperable technology. Conclusions Both community and enterprise HIEs support aggregating clinical data and following patients across settings. Although they can be complementary, community and enterprise HIEs nonetheless compete for providers’ attention and organizational resources. Health policymakers might try to encourage the type of widespread information exchange pursued by community HIEs, but the business case for enterprise HIEs clearly is stronger. The sustainability of a community HIE, potentially a public good, may necessitate ongoing public funding and supportive regulation. PMID:26994710

Differing Strategies to Meet Information-Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems' Enterprise Health Information Exchanges.

PubMed

Vest, Joshua R; Kash, Bita A

2016-03-01

Community health information exchanges have the characteristics of a public good, and they support population health initiatives at the state and national levels. However, current policy equally incentivizes health systems to create their own information exchanges covering more narrowly defined populations. Noninteroperable electronic health records and vendors' expensive custom interfaces are hindering health information exchanges. Moreover, vendors are imposing the costs of interoperability on health systems and community health information exchanges. Health systems are creating networks of targeted physicians and facilities by funding connections to their own enterprise health information exchanges. These private networks may change referral patterns and foster more integration with outpatient providers. The United States has invested billions of dollars to encourage the adoption of and implement the information technologies necessary for health information exchange (HIE), enabling providers to efficiently and effectively share patient information with other providers. Health care providers now have multiple options for obtaining and sharing patient information. Community HIEs facilitate information sharing for a broad group of providers within a region. Enterprise HIEs are operated by health systems and share information among affiliated hospitals and providers. We sought to identify why hospitals and health systems choose either to participate in community HIEs or to establish enterprise HIEs. We conducted semistructured interviews with 40 policymakers, community and enterprise HIE leaders, and health care executives from 19 different organizations. Our qualitative analysis used a general inductive and comparative approach to identify factors influencing participation in, and the success of, each approach to HIE. Enterprise HIEs support health systems' strategic goals through the control of an information technology network consisting of desired trading partners. Community HIEs support obtaining patient information from the broadest set of providers, but with more dispersed benefits to all participants, the community, and patients. Although not an either/or decision, community and enterprise HIEs compete for finite organizational resources like time, skilled staff, and money. Both approaches face challenges due to vendor costs and less-than-interoperable technology. Both community and enterprise HIEs support aggregating clinical data and following patients across settings. Although they can be complementary, community and enterprise HIEs nonetheless compete for providers' attention and organizational resources. Health policymakers might try to encourage the type of widespread information exchange pursued by community HIEs, but the business case for enterprise HIEs clearly is stronger. The sustainability of a community HIE, potentially a public good, may necessitate ongoing public funding and supportive regulation. © 2016 Milbank Memorial Fund.

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 4. Results: specific problem solving skills.

PubMed

Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; van Royen, Paul

2010-09-01

The 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. The previous articles presented background, objectives, and methodology, as well results on 'primary care management' and 'community orientation' and the person-related core competencies of GP/FM. This article reflects on the general practitioner's 'specific problem solving skills'. These include decision making on diagnosis and therapy of specific diseases, accounting for the properties of primary care, but also research questions related to quality management and resource use, shared decision making, or professional education and development. Clinical research covers most specific diseases, but often lacks pragmatism and primary care relevance. Quality management is a stronghold of GP/FM research. Educational interventions can be effective when well designed for a specific setting and situation. However, their message that 'usual care' by general practitioners is insufficient may be problematic. GP and their patients need more research into diagnostic reasoning with a step-wise approach to increase predictive values in a setting characterized by uncertainty and low prevalence of specific diseases. Pragmatic comparative effectiveness studies of new and established drugs or non-pharmaceutical therapy are needed. Multi-morbidity and complexity should be addressed. Studies on therapy, communication strategies and educational interventions should consider impact on health and sustainability of effects.

Use of GIS to identify optimal settings for cancer prevention and control in African American communities

PubMed Central

Alcaraz, Kassandra I.; Kreuter, Matthew W.; Bryan, Rebecca P.

2009-01-01

Objective Rarely have Geographic Information Systems (GIS) been used to inform community-based outreach and intervention planning. This study sought to identify community settings most likely to reach individuals from geographically localized areas. Method An observational study conducted in an urban city in Missouri during 2003–2007 placed computerized breast cancer education kiosks in seven types of community settings: beauty salons, churches, health fairs, neighborhood health centers, Laundromats, public libraries and social service agencies. We used GIS to measure distance between kiosk users’ (n=7,297) home ZIP codes and the location where they used the kiosk. Mean distances were compared across settings. Results Mean distance between individuals’ home ZIP codes and the location where they used the kiosk varied significantly (p<0.001) across settings. The distance was shortest among kiosk users in Laundromats (2.3 miles) and public libraries (2.8 miles) and greatest among kiosk users at health fairs (7.6 miles). Conclusion Some community settings are more likely than others to reach highly localized populations. A better understanding of how and where to reach specific populations can complement the progress already being made in identifying populations at increased disease risk. PMID:19422844

Community-Acquired Methicillin-Resistant "Staphylococcus aureus": Considerations for School Nurses

ERIC Educational Resources Information Center

Alex, Aniltta; Letizia, MariJo

2007-01-01

Methicillin-resistant "Staphylococcus aureus" (MRSA) is a disease-causing organism that has been present in hospital settings since the 1960s. However, a genetically distinct strain of MRSA, called community-acquired methicillin-resistant "Staphylococcus aureus" (CA-MRSA), has emerged in recent years in community settings among healthy…

Anthropogenic organic compounds in ground water and finished water of community water systems in the Greater Twin Cities metropolitan area, Minnesota and Wisconsin, 2004–05

USGS Publications Warehouse

Tornes, Lan H.; Stark, James R.; Hoard, Christopher J.; Smith, Erik A.

2007-01-01

Water-quality results from source-water samples were compared to characterize differences between aquifers. VOC and other AOC detections were more frequent in water from the Prairie du Chien-Jordan aquifer compared to the glacial aquifer. Pesticides, however, were detected more frequently in the glacial aquifer. On the basis of study results, the hydrogeologic setting, land use, and aquifer productivity are important in explaining the occurrence of AOCs in community water system wells. Results of this study indicate that monitoring for pesticides in source water generally indicates the potential occurrence of pesticides in finished water but that this is not necessarily true of VOCs. Additional monitoring is needed to better understand the occurrence of other AOCs in source and finished waters.

Development and evaluation of online evidence based guideline bank system.

PubMed

Park, Myonghwa

2006-01-01

The purpose of this study was to develop and evaluate the online evidence-based nursing practice guideline bank system to support the best evidence-based decision in the clinical and community practice settings. The main homepage consisted of seven modules for introduction of site, EBN, guideline bank, guideline development, guideline review, related sites, and community. The major contents in the guidelines were purpose, developer, intended audience, method of development, target population, testing, knowledge components, and evaluation. Electronic versions of the guidelines were displayed by XML, PDF, and PDA versions. The system usability were evaluated by general users, guideline developers, and guideline reviewers on the web and the results showed high scores of satisfaction. This online evidence-based guideline bank system could support nurses' best and cost-effective clinical decision using the sharable standardized guidelines with education module of evidence based nursing.

Community perspectives

NASA Technical Reports Server (NTRS)

1975-01-01

General aviation is considered from the perspective of the local community's decision-making process in determining its needs for access to general aviation services. The decision-making model, preliminary decision, community characteristics, and planning processes are discussed.

Increased gait unsteadiness in community-dwelling elderly fallers

NASA Technical Reports Server (NTRS)

Hausdorff, J. M.; Edelberg, H. K.; Mitchell, S. L.; Goldberger, A. L.; Wei, J. Y.

1997-01-01

OBJECTIVE: To test the hypothesis that quantitative measures of gait unsteadiness are increased in community-dwelling elderly fallers. STUDY DESIGN: Retrospective, case-control study. SETTING: General community. PARTICIPANTS: Thirty-five community-dwelling elderly subjects older than 70 years of age who were capable of ambulating independently for 6 minutes were categorized as fallers (age, 82.2 +/- 4.9 yrs [mean +/- SD]; n = 18) and nonfallers (age, 76.5 +/- 4.0 yrs; n = 17) based on history; 22 young (age, 24.6 +/- 1.9 yrs), healthy subjects also participated as a second reference group. MAIN OUTCOME MEASURES: Stride-to-stride variability (standard deviation and coefficient of variation) of stride time, stance time, swing time, and percent stance time measured during a 6-minute walk. RESULTS: All measures of gait variability were significantly greater in the elderly fallers compared with both the elderly nonfallers and the young subjects (p < .0002). In contrast, walking speed of the elderly fallers was similar to that of the nonfallers. There were little or no differences in the variability measures of the elderly nonfallers compared with the young subjects. CONCLUSIONS: Stride-to-stride temporal variations of gait are relatively unchanged in community-dwelling elderly nonfallers, but are significantly increased in elderly fallers. Quantitative measurement of gait unsteadiness may be useful in assessing fall risk in the elderly.

Barriers to hospital delivery in a rural setting in Coast Province, Kenya: community attitude and behaviours.

PubMed

Mwangome, Francis K; Holding, Penny A; Songola, Kennedy M; Bomu, Grace K

2012-01-01

A minority of births in sub-Saharan African regions are conducted with the supervision of skilled birth attendants. With among the highest world-wide maternal mortality ratios and the majority of the deaths being associated with a lack of trained supervision at delivery, changing delivery practices is a major priority in this world region. This study identified attitudes to and beliefs about the uptake of hospital services for birthing. Data were gathered using a combination of individual interviews and group discussions. Twelve discussion groups were held with participants who included hospital staff and general community members (36 males and 54 females). In addition, individual interviews were carried out with 26 mothers who chose not to deliver their babies in hospital. Qualitative analysis identified a number of barriers to seeking skilled attendants at birth including: lack of resources (monetary, transport and access), customer care (lack of partnership between mother and health professional), and knowledge and beliefs (lack of knowledge about pregnancy and maternal health). The community must be better informed about the costs and benefits of hospital deliveries, while medical services must be more sensitive to community needs and preferences. These findings prompted the initiation of consultation groups on health and maternal issues between health service providers and community organisations.

Developing Theoretically Based and Culturally Appropriate Interventions to Promote Hepatitis B Testing in 4 Asian American Populations, 2006–2011

PubMed Central

Bastani, Roshan; Glenn, Beth A.; Taylor, Victoria M.; Nguyen, Tung T.; Stewart, Susan L.; Burke, Nancy J.; Chen, Moon S.

2014-01-01

Introduction Hepatitis B infection is 5 to 12 times more common among Asian Americans than in the general US population and is the leading cause of liver disease and liver cancer among Asians. The purpose of this article is to describe the step-by-step approach that we followed in community-based participatory research projects in 4 Asian American groups, conducted from 2006 through 2011 in California and Washington state to develop theoretically based and culturally appropriate interventions to promote hepatitis B testing. We provide examples to illustrate how intervention messages addressing identical theoretical constructs of the Health Behavior Framework were modified to be culturally appropriate for each community. Methods Intervention approaches included mass media in the Vietnamese community, small-group educational sessions at churches in the Korean community, and home visits by lay health workers in the Hmong and Cambodian communities. Results Use of the Health Behavior Framework allowed a systematic approach to intervention development across populations, resulting in 4 different culturally appropriate interventions that addressed the same set of theoretical constructs. Conclusions The development of theory-based health promotion interventions for different populations will advance our understanding of which constructs are critical to modify specific health behaviors. PMID:24784908

Design and methodology of a community-based cluster-randomized controlled trial for dietary behaviour change in rural Kerala.

PubMed

Daivadanam, Meena; Wahlstrom, Rolf; Sundari Ravindran, T K; Sarma, P S; Sivasankaran, S; Thankappan, K R

2013-07-17

Interventions targeting lifestyle-related risk factors and non-communicable diseases have contributed to the mainstream knowledge necessary for action. However, there are gaps in how this knowledge can be translated for practical day-to-day use in complex multicultural settings like that in India. Here, we describe the design of the Behavioural Intervention for Diet study, which was developed as a community-based intervention to change dietary behaviour among middle-income households in rural Kerala. This was a cluster-randomized controlled trial to assess the effectiveness of a sequential stage-matched intervention to bring about dietary behaviour change by targeting the procurement and consumption of five dietary components: fruits, vegetables, salt, sugar, and oil. Following a step-wise process of pairing and exclusion of outliers, six out of 22 administrative units in the northern part of Trivandrum district, Kerala state were randomly selected and allocated to intervention or control arms. Trained community volunteers carried out the data collection and intervention delivery. An innovative tool was developed to assess household readiness-to-change, and a household measurement kit and easy formulas were introduced to facilitate the practical side of behaviour change. The 1-year intervention included a household component with sequential stage-matched intervention strategies at 0, 6, and 12 months along with counselling sessions, telephonic reminders, and home visits and a community component with general awareness sessions in the intervention arm. Households in the control arm received information on recommended levels of intake of the five dietary components and general dietary information leaflets. Formative research provided the knowledge to contextualise the design of the study in accordance with socio-cultural aspects, felt needs of the community, and the ground realities associated with existing dietary procurement, preparation, and consumption patterns. The study also addressed two key issues, namely the central role of the household as the decision unit and the long-term sustainability through the use of existing local and administrative networks and community volunteers.

Expert Opinion and Recommendations for the Management of Attention-Deficit/Hyperactivity Disorder in Correctional Facilities.

PubMed

Scott, Duncan A; Gignac, Martin; Kronfli, Risk N; Ocana, Anthony; Lorberg, Gunter W

2016-01-01

There has been considerably less research on the management of adult attention-deficit/hyperactivity disorder (ADHD) among the inmates of correctional facilities than in the general community. While the successful identification and management of ADHD in the adult correctional setting offer potential benefits to the individuals themselves, to institutional staff, and to wider society, their implementation represents significant challenges. These include high prevalence rates, the low level of ADHD recognition, the high incidence of comorbid psychiatric disorders, and the high risk of abuse and diversion of prescribed medications. Here, the authors provide an overview of current recommendations for the identification and management of adults with ADHD in correctional settings and discuss possible strategies for their further development. © The Author(s) 2015.

Guidelines for a palliative approach for aged care in the community setting: A suite of resources.

PubMed

Toye, Christine; Blackwell, Scott; Maher, Sean; Currow, David C; Holloway, Kristi; Tieman, Jennifer; Hegarty, Meg

2012-01-01

In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary.The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two 'plain English' booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers.The resources are intended to facilitate home care that acknowledges and plans for the client's deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations or residential placements and clinically futile interventions are also minimised.

COPD patients' medical care and support in Greece during financial crisis.

PubMed

Mitonas, George; Juvana, Alexia; Daniil, Zoe; Hatzoglou, Chryssa; Gourgoulianis, Konstantinos

2016-01-01

The need to follow a multidisciplinary strategy in chronic obstructive pulmonary disease (COPD) management and rehabilitation in community settings in Greece raises significant questions, given the severe austerity measures being imposed at present. The aim of this study was to investigate the clinical profile of patients with COPD along with the care provided in rural community settings in Greece. Two primary health care centers and 200 newly diagnosed patients over a 12-month period were involved in the study. A self-assessment questionnaire, including questions about smoking habits, the presence of comorbidities and chronic respiratory symptoms, as well as the COPD Assessment Test were used. Spirometry was performed with a dry spirometer. Obstructive spirometry was defined as forced expiratory volume in 1 second/forced vital capacity ratio <0.7, according to Global Initiative for Chronic Obstructive Lung Disease guidelines. Males comprised 70% of the sample, with cough and sputum being the prominent signs. Regarding COPD staging, 68.5% were classified in stages I/II. Arterial hypertension and coronary heart disease were the most common comorbidities. Current smokers accounted for 88.5%, while 88% were heavy drinkers. A general practitioner made the diagnosis in 68.5% of the cases, among which offspring and spouses provided home care in 38% and 8% of the cases, respectively, while an informal caregiver other than a relative was reported in 34% of the cases. No caregiver (self-care) was reported in 20% of the cases. All patients of stage III and IV had a COPD Assessment Test score >10. Patients with COPD dwelling in the community exhibit an overall mild-to-moderate type of COPD. General practitioner is in charge of COPD management. Informal caregiving is the major type of home care, with nonfamily members playing a significant role. The patients' profile permits limited optimism about their future perspective and urges for immediate action at primary care level.

Chinese Version of the EQ-5D Preference Weights: Applicability in a Chinese General Population

PubMed Central

Wu, Chunmei; Gong, Yanhong; Wu, Jiang; Zhang, Shengchao; Yin, Xiaoxv; Dong, Xiaoxin; Li, Wenzhen; Cao, Shiyi; Mkandawire, Naomie; Lu, Zuxun

2016-01-01

Objectives This study aimed to test the reliability, validity and sensitivity of Chinese version of the EQ-5D preference weights in Chinese general people, examine the differences between the China value set and the UK, Japan and Korea value sets, and provide methods for evaluating and comparing the EQ-5D value sets of different countries. Methods A random sample of 2984 community residents (15 years or older) were interviewed using a questionnaire including the EQ-5D scale. Level of agreement, convergent validity, known-groups validity and sensitivity of the EQ-5D China, United Kingdom (UK), Japan and Korea value sets were determined. Results The mean EQ-5D index scores were significantly (P<0.05) different among the UK (0.964), Japan (0.981), Korea (0.987), and China (0.985) weights. High level of agreement (intraclass correlations coefficients > 0.75) and convergent validity (Pearson’s correlation coefficients > 0.95) were found between each paired schemes. The EQ-5D index scores discriminated equally well for the four versions between levels of 10 known-groups (P< 0.05). The effect size and the relative efficiency statistics showed that the China weights had better sensitivity. Conclusions The China EQ-5D preference weights show equivalent psychometric properties with those from the UK, Japan and Korea weights while slightly more sensitive to known group differences than those from the Japan and Korea weights. Considering both psychometric and sociocultural issues, the China scheme should be a priority as an EQ-5D based measure of the health related quality of life in Chinese general population. PMID:27711169

Good validity of the international spinal cord injury quality of life basic data set.

PubMed

Post, M W M; Adriaansen, J J E; Charlifue, S; Biering-Sørensen, F; van Asbeck, F W A

2016-04-01

Cross-sectional validation study. To examine the construct and concurrent validity of the International Spinal Cord Injury (SCI) Quality of Life (QoL) Basic Data Set. Dutch community. People 28-65 years of age, who obtained their SCI between 18 and 35 years of age, were at least 10 years post SCI and were wheelchair users in daily life. MEASURE(S): The International SCI QoL Basic Data Set consists of three single items on satisfaction with life as a whole, physical health and psychological health (0=complete dissatisfaction; 10=complete satisfaction). Reference measures were the Mental Health Inventory-5 and three items of the World Health Organization Quality of Life measure. Data of 261 participants were available. Mean time after SCI was 24.1 years (s.d. 9.1); 90.4% had a traumatic SCI, 81.5% a motor complete SCI and 40% had tetraplegia. Mean age was 47.9 years (s.d. 8.8) and 73.2% were male. Mean scores were 6.9 (s.d. 1.9) for general QoL, 5.8 (s.d. 2.2) for physical health and 7.1 (s.d. 1.9) for psychological health. No floor or ceiling effects were found. Strong inter-correlations (0.48-0.71) were found between the items, and Cronbach's alpha of the scale was good (0.81). Correlations with the reference measures showed the strongest correlations between the WHOQOL general satisfaction item and general QoL (0.64), the WHOQOL health and daily activities items and physical health (0.69 and 0.60) and the Mental Health Inventory-5 and psychological health (0.70). This first validity study of the International SCI QoL Basic Data Set shows that it appears valid for persons with SCI.

Community Interventions to Improve Glycemic Control in African Americans With Type 2 Diabetes: A Systemic Review

PubMed Central

Smalls, Brittany L.; Walker, Rebekah J.; Bonilha, Heather S.; Campbell, Jennifer A.; Egede, Leonard E.

2015-01-01

Purpose: The purpose of this study was to conduct a systematic review of published community interventions to evaluate different components of community interventions and their ability to positively impact glycemic control in African Americans with T2DM. Methods: Medline, PsychInfo, and CINAHL were searched for potentially eligible studies published from January 2000 through January 2012. The following inclusion criteria were established for publications: (1) describe a community intervention, not prevention; (2) specifically indicate, in data analysis and results, the impact of the community intervention on African American adults, 18 years and older; (3) measure glycemic control (HbA1C) as an outcome measure; and (4) involve patients in a community setting, which excludes hospitals and hospital clinics. Results: Thirteen studies out of 9,233 articles identified in the search met the predetermined inclusion criteria. There were 5 randomized control trials and 3 reported improved glycemic control in the intervention group compared to the control group at the completion of the study. Of the 8 studies that were not randomized control trials, 6 showed a statistically significant change in HbA1C. Conclusion: In general, the community interventions assessed led to significant reductions in HbA1C in African Americans with type 2 diabetes. Community health workers did not have a greater impact on glycemic control in this sample. The findings of this study provides insight for designing community-based interventions in the future, such as including use of multiple delivery methods, consideration of mobile device software, nutritionist educator, and curriculum-based approaches. PMID:26156923

A Multisite Study of the Prevalence of HIV With Rapid Testing in Mental Health Settings

PubMed Central

Blank, Michael B.; Himelhoch, Seth S.; Balaji, Alexandra B.; Metzger, David S.; Dixon, Lisa B.; Rose, Charles E.; Oraka, Emeka; Davis-Vogel, Annet; Thompson, William W.; Heffelfinger, James D.

2014-01-01

Objectives. We estimated HIV prevalence and risk factors among persons receiving mental health treatment in Philadelphia, Pennsylvania, and Baltimore, Maryland, January 2009 to August 2011. Methods. We used a multisite, cross-sectional design stratified by clinical setting. We tested 1061 individuals for HIV in university-based inpatient psychiatric units (n = 287), intensive case-management programs (n = 273), and community mental health centers (n = 501). Results. Fifty-one individuals (4.8%) were HIV-infected. Confirmed positive HIV tests were 5.9% (95% confidence interval [CI] = 3.7%, 9.4%) for inpatient units, 5.1% (95% CI = 3.1%, 8.5%) for intensive case-management programs, and 4.0% (95% CI = 2.6%, 6.1%) for community mental health centers. Characteristics associated with HIV included Black race, homosexual or bisexual identity, and HCV infection. Conclusions. HIV prevalence for individuals receiving mental health services was about 4 times as high as in the general population. We found a positive association between psychiatric symptom severity and HIV infection, indicating that engaging persons with mental illness in appropriate mental health treatment may be important to HIV prevention. These findings reinforce recommendations for routine HIV testing in all clinical settings to ensure that HIV-infected persons receiving mental health services are identified and referred to timely infectious disease care. PMID:24524493

Stigma and discrimination experienced by people living with severe and persistent mental illness in assertive community treatment settings.

PubMed

Ye, Jing; Chen, Timothy F; Paul, Diane; McCahon, Rebecca; Shankar, Sumitra; Rosen, Alan; O'Reilly, Claire L

2016-09-01

To describe the perceived experiences of stigma and discrimination among people living with severe and persistent mental illness in assertive community treatment (ACT teams) settings in New South Wales (NSW), Australia. The Discrimination and Stigma Scale (DISC) was used in this cross-sectional study with people living with severe and persistent mental illness. The DISC is a reliable and valid, quantitative and qualitative instrument used to explore and measure levels of negative, anticipated and positive discrimination. Relevant clinical history and socio-demographic information were also collected. A total of 50 clients participated, with 40 (80%) reporting experienced negative discrimination in at least one life area. Negative discrimination was most commonly experienced in being avoided or shunned (n=25, 50%), by neighbours (n=24, 48%) and family (n=23, 46%). Anticipated discrimination was common, with half of participants (n=25, 50%) feeling the need to conceal their mental health diagnosis. Discrimination was highly prevalent in everyday aspects of life. While healthcare professionals often tend to increase perceived stigma and discrimination, this was only experienced in interactions with general health professionals, while interactions with ACT team members decreased perceived stigma and increased positive discrimination. This indicates that healthcare professionals potentially have a significant role in reducing stigma and discrimination in mental health and that such an effect may be optimised in an ACT team setting. © The Author(s) 2016.

Five-year follow-up of Community Pediatrics Training Initiative.

PubMed

Minkovitz, Cynthia S; Goldshore, Matt; Solomon, Barry S; Guyer, Bernard; Grason, Holly

2014-07-01

To compare community involvement of pediatricians exposed to enhanced residency training as part of the Dyson Community Pediatrics Training Initiative (CPTI) with involvement reported by a national sample of pediatricians. A cross-sectional analyses compared 2008-2010 mailed surveys of CPTI graduates 5 years after residency graduation with comparably aged respondents in a 2010 mailed national American Academy of Pediatrics survey of US pediatricians (CPTI: n = 234, response = 56.0%; national sample: n = 243; response = 59.9%). Respondents reported demographic characteristics, practice characteristics (setting, time spent in general pediatrics), involvement in community child health activities in past 12 months, use of ≥1 strategies to influence community child health (eg, educate legislators), and being moderately/very versus not at all/minimally skilled in 6 such activities (eg, identify community needs). χ(2) statistics assessed differences between groups; logistic regression modeled the independent association of CPTI with community involvement adjusting for personal and practice characteristics and perspectives regarding involvement. Compared with the national sample, more CPTI graduates reported involvement in community pediatrics (43.6% vs 31.1%, P < .01) and being moderately/very skilled in 4 of 6 community activities (P < .05). Comparable percentages used ≥1 strategies (52.2% vs 47.3%, P > .05). Differences in involvement remained in adjusted analyses with greater involvement by CPTI graduates (adjusted odds ratio 2.4, 95% confidence interval 1.5-3.7). Five years after residency, compared with their peers, more CPTI graduates report having skills and greater community pediatrics involvement. Enhanced residency training in community pediatrics may lead to a more engaged pediatrician workforce. Copyright © 2014 by the American Academy of Pediatrics.

Social Network Analysis and Qualitative Interviews for Assessing Geographic Characteristics of Tourism Business Networks.

PubMed

Kelman, Ilan; Luthe, Tobias; Wyss, Romano; Tørnblad, Silje H; Evers, Yvette; Curran, Marina Martin; Williams, Richard J; Berlow, Eric L

2016-01-01

This study integrates quantitative social network analysis (SNA) and qualitative interviews for understanding tourism business links in isolated communities through analysing spatial characteristics. Two case studies are used, the Surselva-Gotthard region in the Swiss Alps and Longyearbyen in the Arctic archipelago of Svalbard, to test the spatial characteristics of physical proximity, isolation, and smallness for understanding tourism business links. In the larger Surselva-Gotthard region, we found a strong relationship between geographic separation of the three communities on compartmentalization of the collaboration network. A small set of businesses played a central role in steering collaborative decisions for this community, while a group of structurally 'peripheral' actors were less influential. By contrast, the business community in Svalbard showed compartmentalization that was independent of geographic distance between actors. Within towns of similar size and governance scale, Svalbard is more compartmentalized, and those compartments are not driven by geographic separation of the collaboration clusters. This compartmentalization in Svalbard was reflected in a lower density of formal business collaboration ties compared to the communities of the Alps. We infer that the difference is due to Svalbard having higher cultural diversity and population turnover than the Alps communities. We propose that integrating quantitative network analysis from simple surveys with qualitative interviews targeted from the network results is an efficient general approach to identify regionally specific constraints and opportunities for effective governance.

Monitoring of Selected Health Indicators in Children Living in a Copper Mine Development Area in Northwestern Zambia

PubMed Central

Knoblauch, Astrid M.; Divall, Mark J.; Owuor, Milka; Archer, Colleen; Nduna, Kennedy; Ng’uni, Harrison; Musunka, Gertrude; Pascall, Anna; Utzinger, Jürg; Winkler, Mirko S.

2017-01-01

The epidemiology of malaria, anaemia and malnutrition in children is potentially altered in mining development areas. In a copper extraction project in northwestern Zambia, a health impact assessment (HIA) was commissioned to predict, manage and monitor health impacts. Two cross-sectional surveys were conducted: at baseline prior to project development (2011) and at four years into development (2015). Prevalence of Plasmodium falciparum, anaemia and stunting were assessed in under-five-year-old children, while hookworm infection was assessed in children aged 9–14 years in communities impacted and comparison communities not impacted by the project. P. falciparum prevalence was significantly higher in 2015 compared to 2011 in both impacted and comparison communities (odds ratio (OR) = 2.51 and OR = 6.97, respectively). Stunting was significantly lower in 2015 in impacted communities only (OR = 0.63). Anaemia was slightly lower in 2015 compared to baseline in both impacted and comparison communities. Resettlement due to the project and migration background (i.e., moving into the area within the past five years) were generally associated with better health outcomes in 2015. We conclude that repeated cross-sectional surveys to monitor health in communities impacted by projects should become an integral part of HIA to deepen the understanding of changing patterns of health and support implementation of setting-specific public health measures. PMID:28335490

Social Network Analysis and Qualitative Interviews for Assessing Geographic Characteristics of Tourism Business Networks

PubMed Central

Luthe, Tobias; Wyss, Romano; Tørnblad, Silje H.; Evers, Yvette; Curran, Marina Martin; Williams, Richard J.; Berlow, Eric L.

2016-01-01

This study integrates quantitative social network analysis (SNA) and qualitative interviews for understanding tourism business links in isolated communities through analysing spatial characteristics. Two case studies are used, the Surselva-Gotthard region in the Swiss Alps and Longyearbyen in the Arctic archipelago of Svalbard, to test the spatial characteristics of physical proximity, isolation, and smallness for understanding tourism business links. In the larger Surselva-Gotthard region, we found a strong relationship between geographic separation of the three communities on compartmentalization of the collaboration network. A small set of businesses played a central role in steering collaborative decisions for this community, while a group of structurally ‘peripheral’ actors were less influential. By contrast, the business community in Svalbard showed compartmentalization that was independent of geographic distance between actors. Within towns of similar size and governance scale, Svalbard is more compartmentalized, and those compartments are not driven by geographic separation of the collaboration clusters. This compartmentalization in Svalbard was reflected in a lower density of formal business collaboration ties compared to the communities of the Alps. We infer that the difference is due to Svalbard having higher cultural diversity and population turnover than the Alps communities. We propose that integrating quantitative network analysis from simple surveys with qualitative interviews targeted from the network results is an efficient general approach to identify regionally specific constraints and opportunities for effective governance. PMID:27258007

First Insights into the Viral Communities of the Deep-sea Anoxic Brines of the Red Sea.

PubMed

Antunes, André; Alam, Intikhab; Simões, Marta Filipa; Daniels, Camille; Ferreira, Ari J S; Siam, Rania; El-Dorry, Hamza; Bajic, Vladimir B

2015-10-01

The deep-sea brines of the Red Sea include some of the most extreme and unique environments on Earth. They combine high salinities with increases in temperature, heavy metals, hydrostatic pressure, and anoxic conditions, creating unique settings for thriving populations of novel extremophiles. Despite a recent increase of studies focusing on these unusual biotopes, their viral communities remain unexplored. The current survey explores four metagenomic datasets obtained from different brine-seawater interface samples, focusing specifically on the diversity of their viral communities. Data analysis confirmed that the particle-attached viral communities present in the brine-seawater interfaces were diverse and generally dominated by Caudovirales, yet appearing distinct from sample to sample. With a level of caution, we report the unexpected finding of Phycodnaviridae, which infects algae and plants, and trace amounts of insect-infecting Iridoviridae. Results from Kebrit Deep revealed stratification in the viral communities present in the interface: the upper-interface was enriched with viruses associated with typical marine bacteria, while the lower-interface was enriched with haloviruses and halophages. These results provide first insights into the unexplored viral communities present in deep-sea brines of the Red Sea, representing one of the first steps for ongoing and future sampling efforts and studies. Copyright © 2015 The Authors. Production and hosting by Elsevier Ltd.. All rights reserved.

Monitoring of Selected Health Indicators in Children Living in a Copper Mine Development Area in Northwestern Zambia.

PubMed

Knoblauch, Astrid M; Divall, Mark J; Owuor, Milka; Archer, Colleen; Nduna, Kennedy; Ng'uni, Harrison; Musunka, Gertrude; Pascall, Anna; Utzinger, Jürg; Winkler, Mirko S

2017-03-19

The epidemiology of malaria, anaemia and malnutrition in children is potentially altered in mining development areas. In a copper extraction project in northwestern Zambia, a health impact assessment (HIA) was commissioned to predict, manage and monitor health impacts. Two cross-sectional surveys were conducted: at baseline prior to project development (2011) and at four years into development (2015). Prevalence of Plasmodium falciparum , anaemia and stunting were assessed in under-five-year-old children, while hookworm infection was assessed in children aged 9-14 years in communities impacted and comparison communities not impacted by the project. P . falciparum prevalence was significantly higher in 2015 compared to 2011 in both impacted and comparison communities (odds ratio (OR) = 2.51 and OR = 6.97, respectively). Stunting was significantly lower in 2015 in impacted communities only (OR = 0.63). Anaemia was slightly lower in 2015 compared to baseline in both impacted and comparison communities. Resettlement due to the project and migration background (i.e., moving into the area within the past five years) were generally associated with better health outcomes in 2015. We conclude that repeated cross-sectional surveys to monitor health in communities impacted by projects should become an integral part of HIA to deepen the understanding of changing patterns of health and support implementation of setting-specific public health measures.

Reexamining free flap breast reconstruction in the community and university setting: is there a difference?

PubMed

Nelson, Jonas A; Stransky, Carrie A; Fischer, John P; Fosnot, Joshua; Serletti, Joseph M; Wu, Liza C

2014-12-01

This study aimed to compare free flap breast reconstruction outcomes in community and university settings to determine whether the latter is necessary for successful performance of this complex procedure. Free tissue transfer procedures for breast reconstruction from 1 university and 1 community hospital performed between 2005 and 2011 were included. Procedures were performed by the same 2 surgeons at both institutions. Demographics and outcome measures were evaluated. Of the 1293 free tissue breast reconstructions performed, 99 (7.7%) were performed in a community hospital and 1194 (92.3%) were performed in a university center. No differences were noted in demographics, comorbidities, or type of free flap reconstruction. However, a number of perioperative characteristics differed. In the community setting, operative time was less (7.3 vs 8.3 hours, P < 0.0001), estimated blood loss was higher (330 vs 248 mL, P < 0.0001), and blood transfusions were more prevalent (24.6% vs 8.3%, P < 0.0001). Furthermore, no significant differences were noted in overall postoperative complications, although a higher rate of abdominal wound infections was noted in the community setting (7.2% vs 2.6%, P = 0.03). The mean number of hospital days was similar between the community and the university (should include value P = 0.44). Although slight differences were noted in a number of perioperative variables and wound complications, we conclude that the key to a successful free tissue transfer reconstruction is in the expertise of the surgeon and not the setting in which it is performed. Despite its complexity, free flap breast reconstruction can be safely and successfully performed in the community setting.

On Target Localization Using Combined RSS and AoA Measurements

PubMed Central

Beko, Marko; Dinis, Rui

2018-01-01

This work revises existing solutions for a problem of target localization in wireless sensor networks (WSNs), utilizing integrated measurements, namely received signal strength (RSS) and angle of arrival (AoA). The problem of RSS/AoA-based target localization became very popular in the research community recently, owing to its great applicability potential and relatively low implementation cost. Therefore, here, a comprehensive study of the state-of-the-art (SoA) solutions and their detailed analysis is presented. The beginning of this work starts by considering the SoA approaches based on convex relaxation techniques (more computationally complex in general), and it goes through other (less computationally complex) approaches, as well, such as the ones based on the generalized trust region sub-problems framework and linear least squares. Furthermore, a detailed analysis of the computational complexity of each solution is reviewed. Furthermore, an extensive set of simulation results is presented. Finally, the main conclusions are summarized, and a set of future aspects and trends that might be interesting for future research in this area is identified. PMID:29671832

Use of bispectral index system (BIS) to Monitor Enteral Conscious (moderate) sedation during general dental procedures.

PubMed

Donaldson, Mark; Goodchild, Jason H

2009-12-01

Although dental board regulations for the provision of in-office enteral conscious (oral) sedation vary widely with respect to training and pharmacologic strategies, they agree on the use of drugs that are inherently safe, the use of pulse oximetry and the availability of emergency equipment, including pharmacologic antagonists. Patient safety is of greatest concern and is best addressed by appropriate selection of patients, adequate training of personnel and appropriate monitoring of patients. Readings from bispectral index system (BIS) monitors, which use electroencephalographic signals, correlate accurately with depth of sedation during nondissociative general anesthesia of adults and children in the operating room setting. The usefulness of such monitoring as an adjunct to other forms of monitoring of in-office enteral sedation in the dental setting may represent the next important application of this tool, adding a further level of safety for the patient and another level of predictability for the practitioner. This paper reviews the current evidence supporting this new technique, presenting data from 20 procedures in which BIS monitoring during in-office enteral sedation was employed in a community dental practice.

Community perspectives on roles and responsibilities for strengthening primary health care in rural Ethiopia.

PubMed

Curry, Leslie A; Alpern, Rachelle; Webster, Tashonna R; Byam, Patrick; Zerihun, Abraham; Tarakeshwar, Nalini; Cherlin, Emily J; Bradley, Elizabeth H

2012-01-01

Government-community partnerships are central to developing effective, sustainable models of primary health care in low-income countries; however, evidence about the nature of partnerships lacks the perspective of community members. Our objective was to characterise community perspectives regarding the respective roles and responsibilities of government and the community in efforts to strengthen primary health care in low-income settings. We conducted a qualitative study using focus groups (n=14 groups in each of seven primary health care units in Amhara and Oromia, Ethiopia, with a total of 140 participants) in the context of the Ethiopian Millennium Rural Initiative. Results indicated that community members defined important roles and responsibilities for both communities and governments. Community roles included promoting recommended health behaviours; influencing social norms regarding health; and contributing resources as feasible. Government roles included implementing oversight of health centres; providing human resources, infrastructure, equipment, medication and supplies; and demonstrating support for community health workers, who are seen as central to the rural health system. Renewed efforts in health system strengthening highlight the importance of community participation in initiatives to improve primary health care in rural settings. Community perspectives provide critical insights to defining, implementing and sustaining partnerships in these settings.

Reference Communities: Applying the Community of Practice Concept to Development of Reference Knowledge

ERIC Educational Resources Information Center

Miller, Robin E.

2011-01-01

Communities of practice offer reference librarians a conceptual model through which to develop and maintain general and subject specific knowledge. Reference librarians acquire general and subject-specific knowledge in many ways, sometimes independently and sometimes collaboratively. Applying the concept of the "community of practice" to reference…

What Works in Community-Based Interventions Promoting Physical Activity and Healthy Eating? A Review of Reviews

PubMed Central

Brand, Tilman; Pischke, Claudia R.; Steenbock, Berit; Schoenbach, Johanna; Poettgen, Saskia; Samkange-Zeeb, Florence; Zeeb, Hajo

2014-01-01

Chronic diseases, such as type II diabetes, are on the rise worldwide. There is consistent evidence that physical activity and healthy eating are important lifestyle factors which affect the risk for chronic diseases. Community-based interventions are of particular public health interest as they reach target groups in their natural living environment and may thus achieve high population-level impacts. We conducted a systematic literature search to assess the effectiveness of community-based interventions to promote physical activity and healthy eating. Specifically, we searched for promising intervention strategies in this setting. We narratively summarized the results of 18 systematic reviews. Among children and adolescents, we found moderate evidence for effects on weight change in primary school-aged children for interventions containing a school component. The evidence for interventions aimed at general adult populations was inconclusive. Self-monitoring, group-based components, and motivational signs to encourage stair use were identified as promising strategies to increase physical activity. Among adults at risk for type II diabetes, evidence was found for beneficial effects on weight change and diabetes incidence. However, interventions for this group were not integrated in more comprehensive community-based approaches. PMID:24886756

Phylum- and Class-Specific PCR Primers for General Microbial Community Analysis

PubMed Central

Blackwood, Christopher B.; Oaks, Adam; Buyer, Jeffrey S.

2005-01-01

Amplification of a particular DNA fragment from a mixture of organisms by PCR is a common first step in methods of examining microbial community structure. The use of group-specific primers in community DNA profiling applications can provide enhanced sensitivity and phylogenetic detail compared to domain-specific primers. Other uses for group-specific primers include quantitative PCR and library screening. The purpose of the present study was to develop several primer sets targeting commonly occurring and important groups. Primers specific for the 16S ribosomal sequences of Alphaproteobacteria, Betaproteobacteria, Bacilli, Actinobacteria, and Planctomycetes and for parts of both the 18S ribosomal sequence and the internal transcribed spacer region of Basidiomycota were examined. Primers were tested by comparison to sequences in the ARB 2003 database, and chosen primers were further tested by cloning and sequencing from soil community DNA. Eighty-five to 100% of the sequences obtained from clone libraries were found to be placed with the groups intended as targets, demonstrating the specificity of the primers under field conditions. It will be important to reevaluate primers over time because of the continual growth of sequence databases and revision of microbial taxonomy. PMID:16204538

Comparing Selected Measures of Health Outcomes and Health-Seeking Behaviors in Chinese, Cambodian, and Vietnamese Communities of Chicago: Results from Local Health Surveys

PubMed Central

Guo, Lucy; Magee, Matthew; Cheung, William; Simon, Melissa; LaBreche, Amanda; Liu, Hong

2010-01-01

We describe how local community organizations partnered to conduct a survey in the Chinese, Cambodian, and Vietnamese populations of Chicago to compare health outcomes and assess progress toward Healthy People 2010 goals. Interviews were conducted with 380 randomly selected Chinese adults through door-to-door sampling, and with 250 Cambodian adults and 150 Vietnamese adults through respondent-driven sampling. Data on 14 key health outcomes are described for this analysis. The three surveyed communities were generally poorer, less educated, more often foreign-born, and had less English proficiency than Asians nationally. There were few significant variations among the three populations, but there were notable differences in the burden of tuberculosis, obesity, diabetes, and arthritis. Insurance coverage and cancer-screening utilization were also significantly lower than for US Asians. Health information about Chinese, Cambodian, and Vietnamese populations in Chicago are available for the first time and serve as baseline data for community interventions. Findings highlight important health concerns for these populations and have implications for funders and policy makers in allocating resources, setting health priorities, and addressing health disparities. PMID:20625846

Understanding cervical cancer prevention and screening in Chuukese women in Hawaii.

PubMed

Wong, Vanessa S; Kawamoto, Crissy T

2010-06-01

Cervical cancer is the primary cause of death due to cancer in women in Chuuk State, Federated States of Micronesia. The Chuukese population is the fastest growing segment of the Micronesian community in Hawaii. Little is known about the health beliefs or practices of this population in Hawaii. The purpose of this project was to describe the knowledge, attitudes, and beliefs of Chuukese women in Hawaii regarding cervical cancer prevention and screening. Research assistants from the Chuukese community were recruited and trained as members of the research team. A culturally sensitive survey tool was developed and piloted by the research team and used to interview ten key informants from the Chuukese community in Honolulu, Hawaii. There is limited knowledge about cervical cancer, especially the association with human papillomavirus (HPV). This may be indicative of a lack of health information in general. Fear, privacy concerns, lack of awareness and cultural beliefs represent the main barriers mentioned when discussing cervical cancer. Education, done in a group setting with other women, is the most recommended method of informing this community and improving preventive and screening services for cervical cancer in these women. Hawaii Medical Journal Copyright 2010.

Newborn Care Practices among Mother-Infant Dyads in Urban Uganda

PubMed Central

Kayom, Violet Okaba; Kakuru, Abel; Kiguli, Sarah

2015-01-01

Background. Most information on newborn care practices in Uganda is from rural communities which may not be generalized to urban settings. Methods. A community based cross-sectional descriptive study was conducted in the capital city of Uganda from February to May 2012. Quantitative and qualitative data on the newborn care practices of eligible mothers were collected. Results. Over 99% of the mothers attended antenatal care at least once and the majority delivered in a health facility. Over 50% of the mothers applied various substances to the cord of their babies to quicken the healing. Although most of the mothers did not bathe their babies within the first 24 hours of birth, the majority had no knowledge of skin to skin care as a thermoprotective method. The practice of bathing babies in herbal medicine was common (65%). Most of the mothers breastfed exclusively (93.2%) but only 60.7% initiated breastfeeding within the first hour of life, while a significant number (29%) used prelacteal feeds. Conclusion. The inadequate newborn care practices in this urban community point to the need to intensify the promotion of universal coverage of the newborn care practices irrespective of rural or urban communities and irrespective of health care seeking indicators. PMID:26713096

Community Discharge of Nursing Home Residents: The Role of Facility Characteristics.

PubMed

Holup, Amanda A; Gassoumis, Zachary D; Wilber, Kathleen H; Hyer, Kathryn

2016-04-01

Using a socio-ecological model, this study examines the influence of facility characteristics on the transition of nursing home residents to the community after a short stay (within 90 days of admission) or long stay (365 days of admission) across states with different long-term services and supports systems. Data were drawn from the Minimum Data Set, the federal Online Survey, Certification, and Reporting (OSCAR) database, the Area Health Resource File, and the LTCFocUs.org database for all free-standing, certified nursing homes in California (n = 1,127) and Florida (n = 657) from July 2007 to June 2008. Hierarchical generalized linear models were used to examine the impact of facility characteristics on the probability of transitioning to the community. Facility characteristics, including size, occupancy, ownership, average length of stay, proportion of Medicare and Medicaid residents, and the proportion of residents admitted from acute care facilities are associated with discharge but differed by state and whether the discharge occurred after a short or long stay. Short- and long-stay nursing home discharge to the community is affected by resident, facility, and sometimes market characteristics, with Medicaid consistently influencing discharge in both states. © Health Research and Educational Trust.

People with an intellectual disability living in an intentional community.

PubMed

Randell, M; Cumella, S

2009-08-01

Hospital closure programmes in England have generally sought to attain a fulfilling life for people with an intellectual disability by locating them in domestic-style housing in urban settings. Few have been placed in intentional or 'village' communities. Yet comparative studies of different housing types have found that intentional communities have better or similar outcomes for their residents than dispersed housing or residential clusters on former hospital sites. A possible explanation is the distinctive pattern of social relationships that exist in many intentional communities and the impact this has on the lives of their residents. This paper reports the results of research that explores the perceptions of people with an ID living in an intentional community and the meaning of their community to them. The research used an ethnographic approach to interview a sample of 15 residents in a large intentional community (Botton Village), which is part of the Camphill Movement. Interviews used Makaton, pictures and symbols where required. Respondents included 10 men and 5 women aged between 38 and 78 years. Length of residence in Botton Village ranged from 5 to 50 years. All lived with the families of co-workers and valued these relationships. All but one (who had retired) worked in a diverse range of employment in the village. Almost all were positive about their work. Respondents reported that they took part in both individual and communal leisure activities and all but two had a network of friends. Opportunities for friendship were enhanced by proximity to other people with an ID and a sense of personal security in the village. As in many villages and communities in society in general, these advantages were balanced by some loss of privacy. Results confirm those from earlier studies of intentional communities and suggest that positive outcomes derive from the absence of the overt subordination of residents to staff, the facilitation of friendship with other people with an ID, high levels of meaningful employment and a sense of community. These factors contrast with the experience of living in small homes funded on a contractual basis by public authorities, in which cost pressures reduce wage levels for staff resulting in difficulties in retaining suitable staff and a consequent high staff turnover.

Ecosystems effects 25 years after Chernobyl: pollinators, fruit set and recruitment.

PubMed

Møller, Anders Pape; Barnier, Florian; Mousseau, Timothy A

2012-12-01

Animals are assumed to play a key role in ecosystem functioning through their effects on seed set, seed consumption, seed dispersal, and maintenance of plant communities. However, there are no studies investigating the consequences of animal scarcity on seed set, seed consumption and seed dispersal at large geographical scales. We exploited the unprecedented scarcity of pollinating bumblebees and butterflies in the vicinity of Chernobyl, Ukraine, linked to the effects of radiation on pollinator abundance, to test for effects of pollinator abundance on the ecosystem. There were considerably fewer pollinating insects in areas with high levels of radiation. Fruit trees and bushes (apple Malus domestica, pear Pyrus communis, rowan Sorbus aucuparia, wild rose Rosa rugosa, twistingwood Viburnum lantana, and European cranberry bush Viburnum opulus) that are all pollinated by insects produced fewer fruit in highly radioactively contaminated areas, partly linked to the local reduction in abundance of pollinators. This was the case even when controlling for the fact that fruit trees were generally smaller in more contaminated areas. Fruit-eating birds like thrushes and warblers that are known seed dispersers were less numerous in areas with lower fruit abundance, even after controlling for the effects of radiation, providing a direct link between radiation, pollinator abundance, fruit abundance and abundance of frugivores. Given that the Chernobyl disaster happened 25 years ago, one would predict reduced local recruitment of fruit trees if fruit set has been persistently depressed during that period; indeed, local recruitment was negatively related to the level of radiation and positively to the local level of fruit set. The patterns at the level of trees were replicated at the level of villages across the study site. This study provides the first large-scale study of the effects of a suppressed pollinator community on ecosystem functioning.

Metabolomic patterns and alcohol consumption in African Americans in the Atherosclerosis Risk in Communities Study123

PubMed Central

Zheng, Yan; Yu, Bing; Alexander, Danny; Steffen, Lyn M; Nettleton, Jennifer A

2014-01-01

Background: Effects of alcohol consumption on health and disease are complex and involve a number of cellular and metabolic processes. Objective: We examined the association between alcohol consumption habits and metabolomic profiles. Design: We conducted a cross-sectional study to explore the association of alcohol consumption habits measured by using a questionnaire with serum metabolites measured by using untargeted mass spectrometry in 1977 African Americans from the Jackson field center in the Atherosclerosis Risk in Communities Study. The whole sample was split into a discovery set (n = 1500) and a replication set (n = 477). Alcohol consumption habits were treated as an ordinal variable, with nondrinkers as the reference group and quartiles of current drinkers as ordinal groups with higher values. For each metabolite, a linear regression was conducted to estimate its relation with alcohol consumption habits separately in both sets. A modified Bonferroni procedure was used in the discovery set to adjust the significance threshold (P < 1.9 × 10−4). Results: In 356 named metabolites, 39 metabolites were significantly associated with alcohol consumption habits in both discovery and replication sets. In general, alcohol consumption was associated with higher levels of most metabolites such as those in amino acid and lipid pathways and with lower levels of γ-glutamyl dipeptides. Three pathways, 2-hydroxybutyrate-related metabolites, γ-glutamyl dipeptides, and lysophosphatidylcholines, which are considered to be involved in inflammation and oxidation, were associated with incident cardiovascular diseases. Conclusions: To our knowledge, this is the largest metabolomic study thus far conducted in nonwhites. Metabolomic biomarkers of alcohol consumption were identified and replicated. The results lend new insight into potential mediating effects between alcohol consumption and future health and disease. PMID:24760976

Historical (1750–2014) anthropogenic emissions of reactive gases and aerosols from the Community Emissions Data System (CEDS)

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

Hoesly, Rachel M.; Smith, Steven J.; Feng, Leyang

Here, we present a new data set of annual historical (1750–2014) anthropogenic chemically reactive gases (CO, CH 4, NH 3, NO x, SO 2, NMVOCs), carbonaceous aerosols (black carbon – BC, and organic carbon – OC), and CO 2 developed with the Community Emissions Data System (CEDS). We improve upon existing inventories with a more consistent and reproducible methodology applied to all emission species, updated emission factors, and recent estimates through 2014. The data system relies on existing energy consumption data sets and regional and country-specific inventories to produce trends over recent decades. All emission species are consistently estimated using the samemore » activity data over all time periods. Emissions are provided on an annual basis at the level of country and sector and gridded with monthly seasonality. These estimates are comparable to, but generally slightly higher than, existing global inventories. Emissions over the most recent years are more uncertain, particularly in low- and middle-income regions where country-specific emission inventories are less available. Future work will involve refining and updating these emission estimates, estimating emissions' uncertainty, and publication of the system as open-source software.« less

Implementing chronic disease self-management in community settings: lessons from Australian demonstration projects.

PubMed

Francis, Caitlin F; Feyer, Anne-Marie; Smith, Ben J

2007-11-01

The evaluation of the Sharing Health Care Initiative addressed the translation of different models of chronic disease self-management into health and community service contexts in Australia. Across seven projects, four intervention models were adopted: (1) the Stanford Chronic Disease Self Management course; (2) generic disease management planning, training and support; (3) tailored disease management planning, training and support, and; (4) telephone coaching. Targeted recruitment through support groups and patient lists was most successful for reaching high-needs clients. Projects with well developed organisational structures and health system networks demonstrated more effective implementation. Engagement of GPs in recruitment and client support was limited. Future self-management programs will require flexible delivery methods in the primary health care setting, involving practice nurses or the equivalent. After 12 months there was little evidence of potential sustainability, although structures such as consumer resource centres and client support clubs were established in some locations. Only one project was able to use Medicare chronic disease-related items to integrate self-management support into routine general practice. Participants in all projects showed improvements in self-management practices, but those receiving Model 3, flexible and tailored support, and Model 4, telephone coaching, reported the greatest benefits.

Historical (1750–2014) anthropogenic emissions of reactive gases and aerosols from the Community Emissions Data System (CEDS)

DOE PAGES

Hoesly, Rachel M.; Smith, Steven J.; Feng, Leyang; ...

2018-01-29

Here, we present a new data set of annual historical (1750–2014) anthropogenic chemically reactive gases (CO, CH 4, NH 3, NO x, SO 2, NMVOCs), carbonaceous aerosols (black carbon – BC, and organic carbon – OC), and CO 2 developed with the Community Emissions Data System (CEDS). We improve upon existing inventories with a more consistent and reproducible methodology applied to all emission species, updated emission factors, and recent estimates through 2014. The data system relies on existing energy consumption data sets and regional and country-specific inventories to produce trends over recent decades. All emission species are consistently estimated using the samemore » activity data over all time periods. Emissions are provided on an annual basis at the level of country and sector and gridded with monthly seasonality. These estimates are comparable to, but generally slightly higher than, existing global inventories. Emissions over the most recent years are more uncertain, particularly in low- and middle-income regions where country-specific emission inventories are less available. Future work will involve refining and updating these emission estimates, estimating emissions' uncertainty, and publication of the system as open-source software.« less

Wetland restoration and birds: lessons from Florida, San Francisco Bay, and Chesapeake Bay

USGS Publications Warehouse

Erwin, R.M.; Frederick, P.C.

2005-01-01

Many wetland restoration projects are underway across the North American landscape, ranging from small, community - based projects of less than 1 ha, to thousands of ha, as in San Francisco Bay or the Everglades. The goals of small projects are generally focused on replanting and sustaining native wetland vegetation, while larger projects often incorporate populations of birds and other vertebrates as part of the criteria for 'success.' Here, I use examples from a number of larger restoration projects from Florida, San Francisco Bay, and Chesapeake Bay, to illustrate several major challenges in planning and implementing those parts of the projects that include waterbirds. These include: (1) setting species priorities at the onset of the project, (2) negotiating among various stakeholders the goals that support wetland ecosystem structural elements (i.e. species and communities) versus those more functionally driven, (3) monitoring reproductive and survival parameters, as well as abundance, to avoid 'sink' situations, and (4) rationalizing control measures for opportunistic species that are not part of the restoration plan. Such projects often provide an ideal setting for the application of adaptive management, but long-term data management and oversight are required to ensure that project 'success' (or failure) is not short-term only.

Historical (1750-2014) anthropogenic emissions of reactive gases and aerosols from the Community Emissions Data System (CEDS)

NASA Astrophysics Data System (ADS)

Hoesly, Rachel M.; Smith, Steven J.; Feng, Leyang; Klimont, Zbigniew; Janssens-Maenhout, Greet; Pitkanen, Tyler; Seibert, Jonathan J.; Vu, Linh; Andres, Robert J.; Bolt, Ryan M.; Bond, Tami C.; Dawidowski, Laura; Kholod, Nazar; Kurokawa, June-ichi; Li, Meng; Liu, Liang; Lu, Zifeng; Moura, Maria Cecilia P.; O'Rourke, Patrick R.; Zhang, Qiang

2018-01-01

We present a new data set of annual historical (1750-2014) anthropogenic chemically reactive gases (CO, CH4, NH3, NOx, SO2, NMVOCs), carbonaceous aerosols (black carbon - BC, and organic carbon - OC), and CO2 developed with the Community Emissions Data System (CEDS). We improve upon existing inventories with a more consistent and reproducible methodology applied to all emission species, updated emission factors, and recent estimates through 2014. The data system relies on existing energy consumption data sets and regional and country-specific inventories to produce trends over recent decades. All emission species are consistently estimated using the same activity data over all time periods. Emissions are provided on an annual basis at the level of country and sector and gridded with monthly seasonality. These estimates are comparable to, but generally slightly higher than, existing global inventories. Emissions over the most recent years are more uncertain, particularly in low- and middle-income regions where country-specific emission inventories are less available. Future work will involve refining and updating these emission estimates, estimating emissions' uncertainty, and publication of the system as open-source software.

Public-academic partnerships: research in community mental health settings: a practicum experience for researchers.

PubMed

Miller, Alexander L; Lopez, Linda; Gonzalez, Jodi M; Dassori, Albana; Bond, Gary; Velligan, Dawn

2008-11-01

Applying research findings to community mental health practices is slowed by provider concerns that research participants often differ from community populations in duration of illness, comorbid conditions, and illness severity. Selecting participants from community settings makes research results demonstrably relevant, but researchers and community providers can be mistrustful of one another, feeling that the other has little understanding of their needs and work. This mistrust impedes patient referrals for research. This column describes a program to increase researcher knowledge of community clinic procedures through structured interactions with clinic personnel. Follow-up interviews indicate improved attitudes and cooperation of researchers and community providers.

A Mixed-Methods Study Examining the Role of the Instructional Coach within a Professional Learning Community

ERIC Educational Resources Information Center

Jorgensen, Christie L.

2016-01-01

Although instructional coaching and professional learning communities provide ongoing, job-embedded support and professional learning, little is known about what role the instructional coach serves within the setting of the professional learning community or what coaching skills teachers find most helpful within this setting. Research examining…

Community Rehabilitation: "Home versus Centre" Guidelines for Choosing the Optimal Treatment Location

ERIC Educational Resources Information Center

Barker, Lauren N.; Ziino, Carlo

2010-01-01

This study aimed to produce indicators and guidelines for clinician use in determining whether individual therapy sessions for community rehabilitation services should be delivered in a home/community-based setting or centre-based setting within a flexible service delivery model. Concept mapping techniques as described by Tochrim and Kane (2005)…

An algorithm for designing minimal microbial communities with desired metabolic capacities

PubMed Central

Eng, Alexander; Borenstein, Elhanan

2016-01-01

Motivation: Recent efforts to manipulate various microbial communities, such as fecal microbiota transplant and bioreactor systems’ optimization, suggest a promising route for microbial community engineering with numerous medical, environmental and industrial applications. However, such applications are currently restricted in scale and often rely on mimicking or enhancing natural communities, calling for the development of tools for designing synthetic communities with specific, tailored, desired metabolic capacities. Results: Here, we present a first step toward this goal, introducing a novel algorithm for identifying minimal sets of microbial species that collectively provide the enzymatic capacity required to synthesize a set of desired target product metabolites from a predefined set of available substrates. Our method integrates a graph theoretic representation of network flow with the set cover problem in an integer linear programming (ILP) framework to simultaneously identify possible metabolic paths from substrates to products while minimizing the number of species required to catalyze these metabolic reactions. We apply our algorithm to successfully identify minimal communities both in a set of simple toy problems and in more complex, realistic settings, and to investigate metabolic capacities in the gut microbiome. Our framework adds to the growing toolset for supporting informed microbial community engineering and for ultimately realizing the full potential of such engineering efforts. Availability and implementation: The algorithm source code, compilation, usage instructions and examples are available under a non-commercial research use only license at https://github.com/borenstein-lab/CoMiDA. Contact: elbo@uw.edu Supplementary information: Supplementary data are available at Bioinformatics online. PMID:27153571

Building up STEM education professional learning community in school setting: Case of Khon Kaen Wittayayon School

NASA Astrophysics Data System (ADS)

Thana, Aduldej; Siripun, Kulpatsorn; Yuenyong, Chokchai

2018-01-01

The STEM education is new issue of teaching and learning in school setting. Building up STEM education professional learning community may provide some suggestions for further collaborative work of STEM Education from grounded up. This paper aimed to clarify the building up STEM education learning community in Khon Kaen Wittayayon (KKW) School setting. Participants included Khon Kaen University researchers, Khon Kaen Wittayayon School administrators and teachers. Methodology regarded interpretative paradigm. The tools of interpretation included participant observation, interview and document analysis. Data was analyzed to categories of condition for building up STEM education professional learning community. The findings revealed that the actions of developing STEM learning activities and research showed some issues of KKW STEM community of inquiry and improvement. The paper will discuss what and how the community learns about sharing vision of STEM Education, supportive physical and social conditions of KKW, sharing activities of STEM, and good things from some key STEM teachers' ambition. The paper may has implication of supporting STEM education in Thailand school setting.

Medication Therapy Management in community pharmacy practice: core elements of an MTM service (version 1.0).

PubMed

2005-01-01

To develop a model framework of Medication Therapy Management (MTM) in community pharmacy designed to improve care, enhance communication among patients and providers, improve collaboration among providers, and optimize medication use that leads to improved patient outcomes. Peer-reviewed literature, structured discussions with community pharmacy leaders and representatives from pharmacy benefit providers and health plans, and input from pharmacists and pharmacy associations. Building on an MTM consensus definition adopted by 11 national pharmacy organizations in July 2004, this model describes core elements of an MTM service that can be provided by pharmacists across the spectrum of community pharmacy. The model is structured for pharmacists to use with all patients in need of MTM services, both in the private and public sector. The model describes five core elements of MTM in the community pharmacy setting: medication therapy review (MTR), a personal medication record (PMR), a medication action plan (MAP), intervention and referral, and documentation and follow-up. The MTR can be comprehensive or targeted, depending onthe needs of the patient. The PMR and MAP are patient-centered documents intended to be used by the patient to improve medication self-management. A collaborative approach to patient care involving patients, pharmacists, and physicians and other health care providers is advocated in the model. General patient eligibility considerations are also described. A model framework for consideration by community pharmacists in developing MTM services is described. The model consists of five core elements for MTM service delivery in community pharmacy practice.

Community perceptions of unintentional child injuries in Makwanpur district of Nepal: a qualitative study

PubMed Central

2014-01-01

Background In Nepal, childhood unintentional injury is an emerging public health problem but it has not been prioritised on national health agenda. There is lack of literature on community perceptions about child injuries. This study has explored community perceptions about child injuries and how injuries can be prevented. Methods Focus group discussions were conducted with mothers, school students and community health volunteers from urban and rural parts of Makwanpur district in Nepal. FGDs were conducted in Nepali languages. These were recorded, transcribed and translated into English. A theoretical framework was identified and thematic analysis conducted. Results Three focus group discussions, with a total of 27 participants, took place. Participants were able to identify examples of child injuries which took place in their community but these generally related to fatal and severe injuries. Participants identified risk factors such as the child’s age, gender, behaviours and whether they had been supervised. Consequences of injuries such as physical and psychological effects, impact on household budgets and disturbance in household plans were identified. Suggestions were made about culturally appropriate prevention measures, and included; suitable supervision arrangements, separation of hazards and teaching about safety to the parents and children. Conclusion Community members in Nepal can provide useful information about childhood injuries and their prevention but this knowledge is not transferred into action. Understanding community perceptions about injuries and their prevention can contribute to the development of preventive interventions in low income settings. PMID:24886124

Social Resources and Community Resilience in the Wake of Superstorm Sandy.

PubMed

Cagney, Kathleen A; Sterrett, David; Benz, Jennifer; Tompson, Trevor

2016-01-01

Recovery efforts after natural disasters typically focus on physical infrastructure. In general less attention is paid to the social infrastructure that might impact the capacity of the community to rebuild. We examine perceptions of preparedness and recovery (markers of resilience at the community level) in the wake of Superstorm Sandy with a novel data set that includes a multi-mode survey of twelve neighborhoods severely affected by the storm. With these data, we suggest that social resources are associated with beliefs about neighborhood resilience. People who live in communities with higher social cohesion (coefficient = .73, p <.001), informal social control (coefficient = .53, p <.001), and social exchange (coefficient = .69, p <.001) are more likely to believe their neighborhoods are well prepared for a disaster. Likewise, people living in communities with higher social cohesion (coefficient = .35, p <.01), informal social control (coefficient = .27, p <.05), and social exchange (coefficient = .42, p <.001) are more likely to be confident their neighborhoods will recover quickly from a disaster. However, the effects of social resources on beliefs about resilience vary based on neighborhood socioeconomic status (SES) and the impact of the storm. Informal social control and social exchange lead to a greater increase in confidence in recovery in low, as compared to high, SES neighborhoods. Social resources tend to have more impact on perceptions of recovery in communities less affected by the storm. In sum, these findings suggest the potential value of various forms of social intervention to better equip communities to respond when disaster strikes.

Portable DNA markers tailored for systematic characterization of Gossypium germplasm

USDA-ARS?s Scientific Manuscript database

Many small-scale ad-hoc studies on characterization of Gossypium germplasm have been conducted that use different sets of markers. Coordination with the cotton community is needed to reach a consensus on the appropriate initial set of DNA markers. In consultation with the cotton community, a set o...

[The role of art therapy in the rehabilitation of psycho-socially disabled people].

PubMed

Simon, Lajos; Kovács, Emese

2015-01-01

The present review focuses on the generally accepted and applied community psychiatry based models of psycho-social rehabilitation. The basics of the Strenghts model and the Recovery based model are introduced in this paper. Both models can be assisted by art therapy in various ways. The forms and the therapeutic factors of art therapy are also discussed, as well as the effects of the creating experience during the art therapy sessions. The authors introduce the good practice of the Moravcsik Foundation with highlights in two special areas that are beyond the generally applied art therapy work and representing important support in reaching the goals set during the rehabilitation process. Further, the authors describe the Budapest Art Brut Gallery and the PsychArt24 art marathon project in details.

Exercise and mental health: a review.

PubMed

Glenister, D

1996-02-01

With the advent of programmes to raise the level of fitness in the general population, and alliances between primary health care and community leisure services, the potential of exercise in promoting mental as well as physical health deserves investigation. In contrast to USA and continental Europe, there is a paucity of British research studies systematically exploring the mental health benefits of exercise. The recent rapid growth of exercise prescription among general practitioners presents an opportunity for future research. This review of eleven randomised control trials (RCTs) suggests a causal relationship between exercise and mental health based upon studies in various settings. The methodological difficulties associated with randomised control trials of psycho-social interventions are discussed. The value of future randomised control trials which incorporate examination of perceived acceptability and health economics is indicated.

Financing and systems barriers to seasonal influenza vaccine delivery in community settings.

PubMed

Penfold, Robert B; Rusinak, Donna; Lieu, Tracy A; Shefer, Abigail; Messonnier, Mark; Lee, Grace M

2011-12-06

Recommendations for annual seasonal influenza vaccination have expanded to now include >300 million children and adults each year. Community settings have become increasingly important venues for influenza vaccination. We sought to identify barriers to and solutions for expanding influenza vaccination in community settings. Semi-structured telephone interviews were conducted from 01/09 to 06/10 with a range of stakeholders involved in influenza vaccination, including health plans, medical services firms, retail based clinics, pharmacies, schools, and state and local public health immunization programs. Participants (n=65) were asked about barriers and feasible solutions to influenza vaccine delivery to children and adults in community settings. Key themes were identified through iterative coding using a grounded theory approach. Stakeholders identified specific financial barriers to influenza vaccine delivery in 3 major areas: purchase and distribution, delivery, and reimbursement. Limited purchasing power, the uncertain nature of public demand, and unpredictable timing of influenza vaccine supply were important barriers to enhance delivery in community settings. Barriers to delivery included complexities in running off-site clinics, especially in school settings, the need to manage publicly vs. privately purchased vaccines separately, and state-to-state variability in requirements for credentialing, physician oversight, and reporting. Reimbursement barriers included a protracted credentialing process, the need to determine insurance eligibility at point-of-service, and lack of a billing infrastructure in off-site clinics. Opportunities to mitigate financial barriers to influenza vaccine delivery in community settings focused on coordination across providers and the role of public health as a "trusted broker" to overcome existing challenges. Financial and systems barriers hamper the optimal use of community settings to effectively deliver influenza vaccines. Public health partners at the federal, state, and local levels are well-positioned to facilitate the engagement of all stakeholders in this important and complex vaccine delivery system. Copyright © 2011 Elsevier Ltd. All rights reserved.

Soboba Community Energy Solar Project - Phase 2

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

Estrada, Steven

This is the final technical report for the Soboba Band of Luiseno Indians' second community solar project. Since time immemorial the descendants of the Soboba people are those whom have lived on and occupied the land that is presently known as the cities of San Jacinto, Hemet, Valle Vista and Winchester. On June 19, 1883, President Chester Arthur by Executive Order established the Soboba Indian Reservation, a 3,172-acre tract which included the Soboba village and the adjacent hills. The President had limited authority as he was only able to set aside public land for the establishment of a reservation andmore » had no authority to take private land. Thus the Soboba village; cultivated lands and major springs were part of Rancho San Jacinto Viejo and belonged to Matthew Byrne. Today the Soboba Indian Reservation lies in the lower reaches of the San Jacinto Mountains, across the San Jacinto River from the city of San Jacinto. The Soboba Band of Luiseño Indians was awarded a community solar grant through the U.S. Department of Energy. The incorporated cities of San Jacinto and Hemet, and the unincorporated community of Valle Vista border the Reservation. All three of these surrounding communities have experienced tremendous population growth over the past two decades, with slower growth during the recent economic downturn. The Tribal community that benefits from under this grant includes 1,161 enrolled members, the majority of which live on the reservation. Nearly 41% of the enrolled members are youth, age 18 and under. The elders and community leaders value preserving and maintaining the Luiseño and Cahuilla cultures and Tribal structure for future generations. The proposed project was administered from the Tribal Administration offices located on the reservation. The Soboba Tribal Government consists of five Tribal Members who are elected by the general membership to Tribal Council for a staggered two year term. The Chairman/Chairwoman is elected by a majority vote of the general membership but the positions for Vice-Chair, Tribal Secretary, Tribal Treasurer and Sergeant at Arms are decided by the elected council. The Soboba Tribal Administration encompasses several departments that serve the needs of the Tribe, the Reservation and the general public. They assist in day-to-day Tribal operations, public safety, Tribal family services, Native American assistance to needy families, cultural preservation, and Tribal environmental protection of natural resources, along with the monitoring of progress and needs of its Enterprises and the general public. The Tribe’s long term energy vision is to become self-sufficient and thereby attain greater control of its destiny, to control costs in view of rapidly rising electric utility expenses, and to maximize the use of renewable energy consistent with sustainable development practices. The project is a Renewable Energy System, specifically a ground mounted, fixed tilt, solar photovoltaic (PV) generating system with a rated capacity of 1.0MWac. The solar generated power serves the electric needs of the affected meters. It benefits every Tribal member since the cost of running the community Tribal facilities, including electric bills, comes out of the General Fund. The estimated 20 year project savings of $ 6,418,064 can be re-directed to other vital community needs, and the project will provide additional jobs for Tribal members. The project has been thoroughly researched and is ready to implement as soon as funding is approved.« less

Organizing a large-scale Physiology Understanding (PhUn) Week event at a science center.

PubMed

VanRyn, Valerie S; Poteracki, James M; Balzer, Micaela; Wehrwein, Erica A

2018-06-01

For the past 6 yr, the Department of Physiology at Michigan State University (MSU) has partnered with Impression 5 Science Center in Lansing, MI. Together, we host a day-long community engagement event on a Saturday each year in early November coinciding with the American Physiological Society's Physiology Understanding Week. The purpose was to provide a fun and memorable hands-on experience for children and families. This paper describes the detailed planning and logistics. The event takes place in the main exhibit space at the science center, generally has 15-17 physiology activities stations set up as booths run by volunteers, and the event runs as an open-house format. Three to five trained volunteers were needed per station for the full day. Since this was primarily based on undergraduate student volunteer involvement (a population already limited for time), morning, afternoon, and/or full-day shifts were offered to accommodate a variety of schedules. Additional set-up, clean-up, and general help was also recruited. Overall, ~100-150 MSU students, faculty, and staff members served as volunteers, alongside Impression 5 staff. Hosting the event at the science center generated a larger audience, aided in advertisement, and allowed for access to a large facility capable of handling the 600-1,000 attendees. The partnership facilitated the sharing of equipment and supplies for physiology demonstrations, allowed for activities on site in the chemistry laboratory space, and facilitated the growth of new community partnerships with local schools and groups who attended the event.

Epidemic spreading on complex networks with community structures

PubMed Central

Stegehuis, Clara; van der Hofstad, Remco; van Leeuwaarden, Johan S. H.

2016-01-01

Many real-world networks display a community structure. We study two random graph models that create a network with similar community structure as a given network. One model preserves the exact community structure of the original network, while the other model only preserves the set of communities and the vertex degrees. These models show that community structure is an important determinant of the behavior of percolation processes on networks, such as information diffusion or virus spreading: the community structure can both enforce as well as inhibit diffusion processes. Our models further show that it is the mesoscopic set of communities that matters. The exact internal structures of communities barely influence the behavior of percolation processes across networks. This insensitivity is likely due to the relative denseness of the communities. PMID:27440176

An efficacy trial of brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial).

PubMed

Laws, Rachel A; Chan, Bibiana C; Williams, Anna M; Davies, Gawaine Powell; Jayasinghe, Upali W; Fanaian, Mahnaz; Harris, Mark F

2010-02-23

Lifestyle risk factors, in particular smoking, nutrition, alcohol consumption and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care (PHC) has been shown to be an effective setting to address lifestyle risk factors at the individual level. However much of the focus of research to date has been in general practice. Relatively little attention has been paid to the role of nurses working in the PHC setting. Community health nurses are well placed to provide lifestyle intervention as they often see clients in their own homes over an extended period of time, providing the opportunity to offer intervention and enhance motivation through repeated contacts. The overall aim of this study is to evaluate the impact of a brief lifestyle intervention delivered by community nurses in routine practice on changes in clients' SNAP risk factors. The trial uses a quasi-experimental design involving four generalist community nursing services in NSW Australia. Services have been randomly allocated to an 'early intervention' group or 'late intervention' (comparison) group. 'Early intervention' sites are provided with training and support for nurses in identifying and offering brief lifestyle intervention for clients during routine consultations. 'Late intervention site' provide usual care and will be offered the study intervention following the final data collection point. A total of 720 generalist community nursing clients will be recruited at the time of referral from participating sites. Data collection consists of 1) telephone surveys with clients at baseline, three months and six months to examine change in SNAP risk factors and readiness to change 2) nurse survey at baseline, six and 12 months to examine changes in nurse confidence, attitudes and practices in the assessment and management of SNAP risk factors 3) semi-structured interviews/focus with nurses, managers and clients in 'early intervention' sites to explore the feasibility, acceptability and sustainability of the intervention. The study will provide evidence about the effectiveness and feasibility of brief lifestyle interventions delivered by generalist community nurses as part of routine practice. This will inform future community nursing practice and PHC policy. ACTRN12609001081202.

From "Water Boiling in a Peruvian Town" to "Letting them Die": culture, community intervention, and the metabolic balance between patience and zeal.

PubMed

Trickett, Edison J

2011-03-01

While the concept of culture has long been central to community psychology research and intervention, it has most frequently referred to the communities in which such work occurs. The purpose of this paper is to reframe this discussion by viewing community interventions as instances of intercultural contact between the culture of science, reflected in community intervention research, and the culture of the communities in which those interventions occur. Following a brief discussion of the complexities of culture as a concept, two illustrative stories of failed community interventions are provided to highlight the centrality of cultural and contextual understanding as prelude to community intervention. These stories, set 50 years apart, reflect the depth and pervasive influence of both the culture of science and the culture of communities. Next, a series of propositions about the culture of social science as a partial reflection of the broader culture of the United States are offered, and their implications for the conduct of community interventions drawn. The paper concludes with a series of recommendations which, together, provide an ecological mind-set for taking culture seriously in community interventions. Central to this mind set are the importance of focusing on communities rather than programs and emphasizing the intervention goal of choice over change.

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

Palinkas, L.A.; Petterson, J.S.; Russell, J.

OBJECTIVE: This study examined the relationship between exposure to the Exxon Valdez oil spill and subsequent cleanup efforts and the prevalence of generalized anxiety disorder, posttraumatic stress disorder (PTSD), and depressive symptoms in 13 Alaska communities. METHOD: A community survey of 599 men and women was conducted approximately 1 year after the spill occurred. Questions from the National Institute of Mental Health Diagnostic Interview Schedule were used to assess symptoms of generalized anxiety disorder and PTSD. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess levels of depressive symptoms. RESULTS: The post-spill (i.e., 1-year) prevalence of generalizedmore » anxiety disorder and PTSD for the study communities with all degrees of exposure was 20.2% and 9.4%, respectively. The prevalence of respondents with CES-D Scale scores above 16 and 18 was 16.6% and 14.2%, respectively. When compared with the unexposed group, members of the high-exposure group were 3.6 times as likely to have generalized anxiety disorder, 2.9 times as likely to have PTSD, 1.8 times as likely to have a CES-D Scale score of 16 and above, and 2.1 times as likely to have a CES-D Scale score of 18 and above. Women exposed to this event were particularly vulnerable to these conditions, and Alaska Natives were particularly vulnerable to depressive symptoms after the oil spill. CONCLUSIONS: The results suggest that the oil spill's impact on the psychosocial environment was as significant as its impact on the physical environment. The Exxon Valdez experience suggests a number of implications for the mental health needs of disaster victims, particularly in primary care settings.« less

Results of Macroinvertebrate Sampling Conducted at 33 SRS Stream Locations, July--August 1993

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

Specht, W.L.

1994-12-01

In order to assess the health of the macroinvertebrate communities of SRS streams, the macroinvertebrate communities at 30 stream locations on SRS were sampled during the summer of 1993, using Hester-Dendy multiplate samplers. In addition, three off-site locations in the Upper Three Runs drainage were sampled in order to assess the potential for impact from off-site activities. In interpreting the data, it is important to recognize that these data were from a single set of collections. Macroinvertebrate communities often undergo considerable temporal variation, and are also greatly influenced by such factors as water depth, water velocity, and available habitat. Thesemore » stations were selected with the intent of developing an on-going sampling program at a smaller number of stations, with the selection of the stations to be based largely upon the results of this preliminary sampling program. When stations within a given stream showed similar results, fewer stations would be sampled in the future. Similarly, if a stream appeared to be perturbed, additional stations or chemical analyses might be added so that the source of the perturbation could be identified. In general, unperturbed streams will contain more taxa than perturbed streams, and the distribution of taxa among orders or families will differ. Some groups of macroinvertebrates, such as Ephemeroptera (mayflies), Plecoptera (stoneflies) and Trichoptera (caddisflies), which are collectively called EPT taxa, are considered to be relatively sensitive to most kinds of stream perturbation; therefore a reduced number of EPT taxa generally indicates that the stream has been subject to chemical or physical stressors. In coastal plain streams, EPT taxa are generally less dominant than in streams with rocky substrates, while Chironomidae (midges) are more abundant. (Abstract Truncated)« less

[General practitioners, community physicians and hospital physicians--how different are they?].

PubMed

Førde, R; Aasland, O G; Akre, V

1996-09-30

In 1993, 9,226 practising physicians in Norway received extensive questionnaires about their health, working and living conditions. In this article we compare municipality employed community physicians (n = 972), general practitioners in private practice (n = 869), and hospital physicians (n = 3,160) with regard to demographic variables and their experience of stress, professional autonomy and job satisfaction. General practitioners report higher job satisfaction and more autonomy than community and hospital physicians, whereas community physicians seem to have a somewhat higher stress level than the two other categories. The experience of general well being, however, is the same in the three groups. General practitioners also spend more time with patients, and are much more satisfied with their income.

Quality indicators for pharmaceutical care: a comprehensive set with national scores for Dutch community pharmacies.

PubMed

Teichert, Martina; Schoenmakers, Tim; Kylstra, Nico; Mosk, Berend; Bouvy, Marcel L; van de Vaart, Frans; De Smet, Peter A G M; Wensing, Michel

2016-08-01

Background The quality of pharmaceutical care in community pharmacies in the Netherlands has been assessed annually since 2008. The initial set has been further developed with pharmacists and patient organizations, the healthcare inspectorate, the government and health insurance companies. The set over 2012 was the first set of quality indicators for community pharmacies which was validated and supported by all major stakeholders. The aims of this study were to describe the validated set of quality indicators for community pharmacies and to report their scores over 2012. In subanalyses the score development over 5 years was described for those indicators, that have been surveyed before and remained unchanged. Methods Community pharmacists in the Netherlands were invited in 2013 to provide information for the set of 2012. Quality indicators were mapped by categories relevant for pharmaceutical care and defined for structures, processes and dispensing outcomes. Scores for categorically-measured quality indicators were presented as the percentage of pharmacies reporting the presence of a quality aspect. For numerical quality indicators, the mean of all reported scores was expressed. In subanalyses for those indicators that had been questioned previously, scores were collected from earlier measurements for pharmacies providing their scores in 2012. Multilevel analysis was used to assess the consistency of scores within one pharmacy over time by the intra-class correlation coefficient (ICC). Results For the set in 2012, 1739 Dutch community pharmacies (88 % of the total) provided information for 66 quality indicators in 10 categories. Indicator scores on the presence of quality structures showed relatively high quality levels. Scores for processes and dispensing outcomes were lower. Subanalyses showed that overall indicators scores improved within pharmacies, but this development differed between pharmacies. Conclusions A set of validated quality indicators provided insight into the quality of pharmaceutical care in the Netherlands. The quality of pharmaceutical care improved over time. As of 2012 quality structures were present in at least 80 % of the community pharmacies. Variation in scores on care processes and outcomes between individual pharmacies and over time can initiate future research to better understand and facilitate quality improvement in community pharmacies.

Building capacity for cognitive behavioral therapy delivery for depression in disaster-impacted contexts.

PubMed

Ngo, Victoria K; Centanni, Angela; Wong, Eunice; Wennerstrom, Ashley; Miranda, Jeanne

2011-01-01

Numerous challenges exist in implementing evidence-based practices, such as cognitive behavioral therapy, in resource poor, ethnic minority, and/or disaster-affected communities with disparities in mental health. Community-academic participatory partnerships are a promising approach to addressing disparities by implementing community-appropriate, evidence-based depression care. A community-academic collaborative was formed in New Orleans after Hurricane Katrina to expand resources for effective depression care, including cognitive behavioral therapy. In this article, we: 1) describe our model of building capacity to deliver cognitive behavioral therapy for depression in post-disaster community-based settings; 2) discuss the impact of this training program on therapist reported practice; and 3) share lessons learned regarding disseminating and sustaining evidence-based interventions in the context of a disaster impacted community. Using a mixed methods approach, we found that this model was feasible, acceptable, and disseminated knowledge about cognitive behavioral therapy in community settings. Over the course of two years, community providers demonstrated the feasibility of implementing evidence-based practice and potential for local community leadership. The lessons learned from this model of implementation may help address barriers to disseminating evidence-based interventions in other low-resource, disaster-impacted community settings.

Albendazole and ivermectin for the control of soil-transmitted helminths in an area with high prevalence of Strongyloides stercoralis and hookworm in northwestern Argentina: A community-based pragmatic study.

PubMed

Echazú, Adriana; Juarez, Marisa; Vargas, Paola A; Cajal, Silvana P; Cimino, Ruben O; Heredia, Viviana; Caropresi, Silvia; Paredes, Gladys; Arias, Luis M; Abril, Marcelo; Gold, Silvia; Lammie, Patrick; Krolewiecki, Alejandro J

2017-10-01

Recommendations for soil-transmitted helminth (STH) control give a key role to deworming of school and pre-school age children with albendazole or mebendazole; which might be insufficient to achieve adequate control, particularly against Strongyloides stercoralis. The impact of preventive chemotherapy (PC) against STH morbidity is still incompletely understood. The aim of this study was to assess the effectiveness of a community-based program with albendazole and ivermectin in a high transmission setting for S. stercoralis and hookworm. Community-based pragmatic trial conducted in Tartagal, Argentina; from 2012 to 2015. Six communities (5070 people) were enrolled for community-based PC with albendazole and ivermectin. Two communities (2721 people) were re-treated for second and third rounds. STH prevalence, anemia and malnutrition were explored through consecutive surveys. Anthropometric assessment of children, stool analysis, complete blood count and NIE-ELISA serology for S. stercoralis were performed. STH infection was associated with anemia and stunting in the baseline survey that included all communities and showed a STH prevalence of 47.6% (almost exclusively hookworm and S. stercoralis). Among communities with multiple interventions, STH prevalence decreased from 62% to 23% (p<0.001) after the first PC; anemia also diminished from 52% to 12% (p<0.001). After two interventions S. stercoralis seroprevalence declined, from 51% to 14% (p<0.001) and stunting prevalence decreased, from 19% to 12% (p = 0.009). Hookworm' infections are associated with anemia in the general population and nutritional impairment in children. S. stercoralis is also associated with anemia. Community-based deworming with albendazole and ivermectin is effective for the reduction of STH prevalence and morbidity in communities with high prevalence of hookworm and S. stercoralis.

Parametric Sensitivity Analysis of Precipitation at Global and Local Scales in the Community Atmosphere Model CAM5

DOE PAGES

Qian, Yun; Yan, Huiping; Hou, Zhangshuan; ...

2015-04-10

We investigate the sensitivity of precipitation characteristics (mean, extreme and diurnal cycle) to a set of uncertain parameters that influence the qualitative and quantitative behavior of the cloud and aerosol processes in the Community Atmosphere Model (CAM5). We adopt both the Latin hypercube and quasi-Monte Carlo sampling approaches to effectively explore the high-dimensional parameter space and then conduct two large sets of simulations. One set consists of 1100 simulations (cloud ensemble) perturbing 22 parameters related to cloud physics and convection, and the other set consists of 256 simulations (aerosol ensemble) focusing on 16 parameters related to aerosols and cloud microphysics.more » Results show that for the 22 parameters perturbed in the cloud ensemble, the six having the greatest influences on the global mean precipitation are identified, three of which (related to the deep convection scheme) are the primary contributors to the total variance of the phase and amplitude of the precipitation diurnal cycle over land. The extreme precipitation characteristics are sensitive to a fewer number of parameters. The precipitation does not always respond monotonically to parameter change. The influence of individual parameters does not depend on the sampling approaches or concomitant parameters selected. Generally the GLM is able to explain more of the parametric sensitivity of global precipitation than local or regional features. The total explained variance for precipitation is primarily due to contributions from the individual parameters (75-90% in total). The total variance shows a significant seasonal variability in the mid-latitude continental regions, but very small in tropical continental regions.« less

EVAPORITE MICROBIAL FILMS, MATS, MICROBIALITES AND STROMATOLITES

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

Brigmon, R; Penny Morris, P; Garriet Smith, G

2008-01-28

Evaporitic environments are found in a variety of depositional environments as early as the Archean. The depositional settings, microbial community and mineralogical composition vary significantly as no two settings are identical. The common thread linking all of the settings is that evaporation exceeds precipitation resulting in elevated concentrations of cations and anions that are higher than in oceanic systems. The Dead Sea and Storrs Lake are examples of two diverse modern evaporitic settings as the former is below sea level and the latter is a coastal lake on an island in the Caribbean. Each system varies in water chemistry asmore » the Dead Sea dissolved ions originate from surface weathered materials, springs, and aquifers while Storrs Lake dissolved ion concentration is primarily derived from sea water. Consequently some of the ions, i.e., Sr, Ba are found at significantly lower concentrations in Storrs Lake than in the Dead Sea. The origin of the dissolved ions are ultimately responsible for the pH of each system, alkaline versus mildly acidic. Each system exhibits unique biogeochemical properties as the extreme environments select certain microorganisms. Storrs Lake possesses significant biofilms and stromatolitic deposits and the alkalinity varies depending on rainfall and storm activity. The microbial community Storrs Lake is much more diverse and active than those observed in the Dead Sea. The Dead Sea waters are mildly acidic, lack stromatolites, and possess a lower density of microbial populations. The general absence of microbial and biofilm fossilization is due to the depletion of HCO{sub 3} and slightly acidic pH.« less

Hand Hygiene – Evaluation of Three Disinfectant Hand Sanitizers in a Community Setting

PubMed Central

Babeluk, Rita; Jutz, Sabrina; Mertlitz, Sarah; Matiasek, Johannes; Klaus, Christoph

2014-01-01

Hand hygiene is acknowledged as the single most important measure to prevent nosocomial infections in the healthcare setting. Similarly, in non-clinical settings, hand hygiene is recognised as a key element in helping prevent the spread of infectious diseases. The aim of this study was to evaluate the efficacy of three different disinfectant hand sanitizers in reducing the burden of bacterial hand contamination in 60 healthy volunteers in a community setting, both before and after education about the correct use of hand sanitizers. The study is the first to evaluate the efficacy and ease of use of different formulations of hand rubs used by the general population. The products tested were: Sterillium (perfumed, liquid), desderman pure gel (odorless, gel) and Lavit (perfumed, spray). Sterillium and desderman are EN1500 (hygienic hand rub) certified products (available in pharmacy) and Lavit is non EN1500 certified and available in supermarkets. The two EN1500 certified products were found to be significantly superior in terms of reducing bacterial load. desderman pure gel, Sterillium and Lavit reduced the bacterial count to 6.4%, 8.2% and 28.0% respectively. After education in the correct use of each hand rub, the bacterial load was reduced even further, demonstrating the value of education in improving hand hygiene. Information about the testers' perceptions of the three sanitizers, together with their expectations of a hand sanitizer was obtained through a questionnaire. Efficacy, followed by skin compatibility were found to be the two most important attributes of a hand disinfectant in our target group. PMID:25379773

Preparing new nurse graduates for practice in multiple settings: a community-based academic-practice partnership model.

PubMed

West, Nikki; Berman, Audrey; Karshmer, Judith; Prion, Susan; Van, Paulina; Wallace, Jonalyn

2014-06-01

Responding to local and national concerns about the nursing workforce, the California Institute for Nursing and Health Care worked with private and public funders and community health care partners to establish community-based transition-to-practice programs for new RN graduates unable to secure nursing positions in the San Francisco Bay Area. The goals were to retain new RN graduates in nursing and further develop their skills and competencies to increase their employability. Leaders from academic and inpatient, ambulatory, and community-based practice settings, as well as additional community partners, collaboratively provided four 12- to 16-week pilot transition programs in 2010-2011. A total of 345 unemployed new nurse graduates enrolled. Eighty-four percent of 188 respondents to a post-program survey were employed in inpatient and community settings 3 months after completion. Participants and clinical preceptors also reported increases in confidence and competence. Copyright 2014, SLACK Incorporated.

A pilot Internet "Value of Health" Panel: recruitment, participation and compliance

PubMed Central

Stein, Ken; Dyer, Matthew; Crabb, Tania; Milne, Ruairidh; Round, Alison; Ratcliffe, Julie; Brazier, John

2006-01-01

Objectives To pilot using a panel of members of the public to provide preference data via the Internet Methods A stratified random sample of members of the general public was recruited and familiarised with the standard gamble procedure using an Internet based tool. Health states were perdiodically presented in "sets" corresponding to different conditions, during the study. The following were described: Recruitment (proportion of people approached who were trained); Participation (a) the proportion of people trained who provided any preferences and (b) the proportion of panel members who contributed to each "set" of values; and Compliance (the proportion, per participant, of preference tasks which were completed). The influence of covariates on these outcomes was investigated using univariate and multivariate analyses. Results A panel of 112 people was recruited. 23% of those approached (n = 5,320) responded to the invitation, and 24% of respondents (n = 1,215) were willing to participate (net = 5.5%). However, eventual recruitment rates, following training, were low (2.1% of those approached). Recruitment from areas of high socioeconomic deprivation and among ethnic minority communities was low. Eighteen sets of health state descriptions were considered over 14 months. 74% of panel members carried out at least one valuation task. People from areas of higher socioeconomic deprivation and unmarried people were less likely to participate. An average of 41% of panel members expressed preferences on each set of descriptions. Compliance ranged from 3% to 100%. Conclusion It is feasible to establish a panel of members of the general public to express preferences on a wide range of health state descriptions using the Internet, although differential recruitment and attrition are important challenges. Particular attention to recruitment and retention in areas of high socioeconomic deprivation and among ethnic minority communities is necessary. Nevertheless, the panel approach to preference measurement using the Internet offers the potential to provide specific utility data in a responsive manner for use in economic evaluations and to address some of the outstanding methodological uncertainties in this field. PMID:17129380

General practice: the DREEM attachment? Comparing the educational environment of hospital and general practice placements.

PubMed

Kelly, Martina; Bennett, Deirdre; O'Flynn, Siun

2012-01-01

The clinical learning environment is changing. General practice placements are now a fundamental part of undergraduate medical education. There is growing recognition that changes in hospital work practices are altering the breadth of exposure available to students. Surprisingly little work has been done comparing the quality of clinical placements between the hospital and community using validated tools. Such comparisons inform curriculum planning and resource allocation. The aim of this study was to compare the quality of the educational environment experienced by junior medical students during hospital and general practice placements using a widely used tool. Following the introduction of a new integrated curriculum, all Year 3 students (n=108) completed a standardised evaluation instrument, the Dundee Ready Education Environment Measure (DREEM) at the end of each of their clinical attachments (two different hospital sites and one in general practice), giving a total of 324 questionnaires. All forms were analysed and input into Graphpad INSTAT version 3. Total DREEM scores as well as subscale scores were calculated for each site. These were compared across sites using a Mann-Whitney U non-parametric test. By comparison with international standards, clinical attachments in our new integrated curriculum were rated highly. In particular, attachments in general practice scored highly with a mean score of 156.6 and perform significantly better (P < 0.01) when compared with the mean score for hospital rotations of 149.0. Significant differences between general practice and hospital rotations exist in the domains of students' perceptions of atmosphere and students' social self-perceptions. Finally, significant differences also emerged in students' perceptions of teachers in general practice when compared to those in the hospital setting. These findings provide evidence of the high-quality educational environment afforded students in primary care. They challenge the traditional emphasis on hospital-based teaching and preempt the question - Is the community a better place for junior students to learn?

Students' clinical experience on outreach placements.

PubMed

Smith, M; Lennon, M A; Robinson, P G

2010-02-01

Primary care outreach placements increasingly feature in UK undergraduate dental curricula. The profile of clinical work undertaken on placement may differ from traditional hospital-based programmes and between outreach settings. An appreciation of any differences could inform curriculum development. To compare the profiles of clinical work experienced on a traditional hospital-based programme and outreach placements in different settings. One dental hospital and eight existing primary care block placements in England. Subjects were four cohorts of senior dental students in one UK dental school. Departmental records provided data on students' clinical experience in different settings and their achievement of placement learning objectives. Descriptive statistics for groups were compared. (1) Counts of patients encountered and of clinical procedures completed in the following categories: simple plastic restorations, endodontics, cast restorations, dentures, extractions and children's dentistry. (2) Student perceptions of placement learning reported via Likert scales. Outreach students encountered twice as many patients and typically completed about three times as much clinical work as students in the hospital, e.g. 44 cf 16 simple plastic restorations, seven cf two endodontic procedures. There were variations in profiles by setting. For example, amalgam being more likely to be used on outreach especially in the General Dental Service; more children's dentistry in community services and more extractions in Dental Access Centres. Students reported learning outcomes generally being achieved (average 94%) although with some variation by setting. Dental outreach training greatly increases the quantity of students' clinical experience in everyday dentistry compared to a hospital-based programme. Placements also increase awareness of service delivery and develop clinical skills. There are appreciable variations between outreach settings possibly reflecting their purposes. Multiple contrasting outreach placements for each student might increase the uniformity of learning experiences.

UpSet: Visualization of Intersecting Sets

PubMed Central

Lex, Alexander; Gehlenborg, Nils; Strobelt, Hendrik; Vuillemot, Romain; Pfister, Hanspeter

2016-01-01

Understanding relationships between sets is an important analysis task that has received widespread attention in the visualization community. The major challenge in this context is the combinatorial explosion of the number of set intersections if the number of sets exceeds a trivial threshold. In this paper we introduce UpSet, a novel visualization technique for the quantitative analysis of sets, their intersections, and aggregates of intersections. UpSet is focused on creating task-driven aggregates, communicating the size and properties of aggregates and intersections, and a duality between the visualization of the elements in a dataset and their set membership. UpSet visualizes set intersections in a matrix layout and introduces aggregates based on groupings and queries. The matrix layout enables the effective representation of associated data, such as the number of elements in the aggregates and intersections, as well as additional summary statistics derived from subset or element attributes. Sorting according to various measures enables a task-driven analysis of relevant intersections and aggregates. The elements represented in the sets and their associated attributes are visualized in a separate view. Queries based on containment in specific intersections, aggregates or driven by attribute filters are propagated between both views. We also introduce several advanced visual encodings and interaction methods to overcome the problems of varying scales and to address scalability. UpSet is web-based and open source. We demonstrate its general utility in multiple use cases from various domains. PMID:26356912

Palliative care for cirrhosis: a UK survey of health professionals’ perceptions, current practice and future needs

PubMed Central

Low, Joseph; Vickerstaff, Victoria; Davis, Sarah; Bichard, Julia; Greenslade, Lynda; Hopkins, Katherine; Marshall, Aileen; Thorburn, Douglas; Jones, Louise

2016-01-01

Objective To determine the knowledge and practice patterns of a UK cohort of relevant healthcare professionals (HCPs) about delivering palliative care in cirrhosis, and to inform priorities for future research. Design An on-line questionnaire survey with closed and open responses. Setting HCPs identified from the mailing list of special interest groups in hepatology and gastroenterology (liver), general practice and specialist palliative care (SPC) across the UK. Results Of the 6181 potential contacts identified, 517 HCPs responded. Most believed a role exists for SPC in caring for people with cirrhosis, but many SPC HCPs felt ill prepared to provide good care to those facing death. Further training was needed in managing liver-related symptoms, symptom control and end of life issues. All HCP groups wished to increase community provision of palliative care support, but many general practitioners felt unable to manage advanced cirrhosis in the community. There were differences in the optimal trigger for SPC referral with liver HCPs less likely to refer at symptom deterioration. Prognostication, symptom management and service configuration were key areas identified for future research. Conclusions All who responded acknowledged the role of SPC in caring for those dying with cirrhosis and need for further training to improve confidence and enable joint working between SPC, general practice and liver teams. Low response rates make it difficult to generalise these findings, which require further validation. PMID:28839829

Recognizing pharmaceutical illiteracy in community pharmacy: Agreement between a practice-based interview guide and questionnaire based assessment.

PubMed

Koster, Ellen S; Philbert, Daphne; van Dijk, Liset; Rademakers, Jany; de Smet, Peter A G M; Bouvy, Marcel L; Vervloet, Marcia

2018-02-02

Patients with limited pharmaceutical literacy are at increased risk of drug-related problems. Recognizing these patients in daily practice is difficult. The Recognition and Addressing of Limited Pharmaceutical Literacy (RALPH) interview guide was developed as practical set of questions to recognize patients with limited pharmaceutical literacy in daily pharmacy practice. To compare agreement between pharmaceutical literacy measured with the RALPH guide and a validated general health literacy questionnaire. In addition, we provide insight into patients' pharmaceutical literacy using the RALPH interview guide. Structured face-to-face interviews with patients who visited a community pharmacy to fill a prescription for themselves were conducted. The interview included the RALPH guide as well as the Functional Communicative Critical Health Literacy (FCCHL) questionnaire to measure general health literacy. Functional, communicative and critical skills were measured and agreement between two methods was calculated. Data were collected from 508 patients. Patients with limited pharmaceutical literacy, indicated by the RALPH questions, also had a lower general health literacy level according to FCCHL scores. Agreement between the RALPH guide and FCCHL questionnaire was moderate (∼60%) for the three health literacy domains. Most patients (>90%) had correct understanding of frequency and timing of medication use, but 25% did not understand warnings or precautions correctly. Finding understandable information (39%), assessing information applicability (50%) and reliability (64%) were mentioned as difficult by patients. Patients experienced difficulties with more complex skills, e.g. interpretation of warnings or precautions when using a medicine, finding and analyzing medication information. Whereas the FCCHL questionnaire is useful to assess general health literacy, the RALPH interview guide provides insight in the level of skills needed for good medication use and is more suitable for use in a medication specific context such as community pharmacy. Context specific assessment of skills is important to provide tailored pharmaceutical care. Copyright © 2018 Elsevier Inc. All rights reserved.

Mixed method evaluation of a community-based physical activity program using the RE-AIM framework: practical application in a real-world setting.

PubMed

Koorts, Harriet; Gillison, Fiona

2015-11-06

Communities are a pivotal setting in which to promote increases in child and adolescent physical activity behaviours. Interventions implemented in these settings require effective evaluation to facilitate translation of findings to wider settings. The aims of this paper are to i) present findings from a RE-AIM evaluation of a community-based physical activity program, and ii) review the methodological challenges faced when applying RE-AIM in practice. A single mixed-methods case study was conducted based on a concurrent triangulation design. Five sources of data were collected via interviews, questionnaires, archival records, documentation and field notes. Evidence was triangulated within RE-AIM to assess individual and organisational-level program outcomes. Inconsistent availability of data and a lack of robust reporting challenged assessment of all five dimensions. Reach, Implementation and setting-level Adoption were less successful, Effectiveness and Maintenance at an individual and organisational level were moderately successful. Only community-level Adoption was highly successful, reflecting the key program goal to provide community-wide participation in sport and physical activity. This research highlighted important methodological constraints associated with the use of RE-AIM in practice settings. Future evaluators wishing to use RE-AIM may benefit from a mixed-method triangulation approach to offset challenges with data availability and reliability.

Successes and Lessons Learned From Implementing Community Health Worker Programs in Community-Based and Clinical Settings: Insights From the Gulf Coast.

PubMed

Sherman, Mya; Covert, Hannah; Fox, Laila; Lichtveld, Maureen

Community health workers (CHWs) are an increasingly viable component of the American health system. While organizations may be interested in incorporating CHWs into the health care workforce, there are challenges to doing so. This study characterizes the successes and lessons learned from implementing new CHW programs in clinical and community-based settings in 4 US Gulf states. Semistructured interviews were conducted with CHWs and their supervisors. Interviews were conducted with participants in 16 community-based organizations and federally qualified health centers located in coastal counties and parishes of Louisiana, Florida, Alabama, and Mississippi. Study participants consisted of 22 CHWs and 17 CHW supervisors. Although most challenges and strategies were reported by participants working in both clinical and community-based settings, some were workplace-specific. Participants from predominantly clinical settings described the importance of strengthening organizational cohesion and coordination, whereas participants from community-based participants discussed the need for specialized training for CHWs. In both work environments, participants indicated that CHW functioning was constrained by limited organizational resources, difficulty accessing the client population, and limited knowledge regarding the CHW's scope of practice. Strategies to improve CHW functioning in both settings included investing in local partnerships, streamlining resources, prioritizing strong communication and outreach, and establishing explicit operating procedures. The majority of participants noted that challenges lessened over time. Evaluating successes and lessons learned in CHW work is critical to maximize CHWs' abilities to address clients' health needs and promote health in underserved communities. This study provides important insights into how to successfully integrate CHWs into the public health workforce.

Proposed minimum reporting standards for chemical analysis Chemical Analysis Working Group (CAWG) Metabolomics Standards Initiative (MSI)

PubMed Central

Amberg, Alexander; Barrett, Dave; Beale, Michael H.; Beger, Richard; Daykin, Clare A.; Fan, Teresa W.-M.; Fiehn, Oliver; Goodacre, Royston; Griffin, Julian L.; Hankemeier, Thomas; Hardy, Nigel; Harnly, James; Higashi, Richard; Kopka, Joachim; Lane, Andrew N.; Lindon, John C.; Marriott, Philip; Nicholls, Andrew W.; Reily, Michael D.; Thaden, John J.; Viant, Mark R.

2013-01-01

There is a general consensus that supports the need for standardized reporting of metadata or information describing large-scale metabolomics and other functional genomics data sets. Reporting of standard metadata provides a biological and empirical context for the data, facilitates experimental replication, and enables the re-interrogation and comparison of data by others. Accordingly, the Metabolomics Standards Initiative is building a general consensus concerning the minimum reporting standards for metabolomics experiments of which the Chemical Analysis Working Group (CAWG) is a member of this community effort. This article proposes the minimum reporting standards related to the chemical analysis aspects of metabolomics experiments including: sample preparation, experimental analysis, quality control, metabolite identification, and data pre-processing. These minimum standards currently focus mostly upon mass spectrometry and nuclear magnetic resonance spectroscopy due to the popularity of these techniques in metabolomics. However, additional input concerning other techniques is welcomed and can be provided via the CAWG on-line discussion forum at http://msi-workgroups.sourceforge.net/ or http://Msi-workgroups-feedback@lists.sourceforge.net. Further, community input related to this document can also be provided via this electronic forum. PMID:24039616

A flexible and economical barcoding approach for highly multiplexed amplicon sequencing of diverse target genes

PubMed Central

Herbold, Craig W.; Pelikan, Claus; Kuzyk, Orest; Hausmann, Bela; Angel, Roey; Berry, David; Loy, Alexander

2015-01-01

High throughput sequencing of phylogenetic and functional gene amplicons provides tremendous insight into the structure and functional potential of complex microbial communities. Here, we introduce a highly adaptable and economical PCR approach to barcoding and pooling libraries of numerous target genes. In this approach, we replace gene- and sequencing platform-specific fusion primers with general, interchangeable barcoding primers, enabling nearly limitless customized barcode-primer combinations. Compared to barcoding with long fusion primers, our multiple-target gene approach is more economical because it overall requires lower number of primers and is based on short primers with generally lower synthesis and purification costs. To highlight our approach, we pooled over 900 different small-subunit rRNA and functional gene amplicon libraries obtained from various environmental or host-associated microbial community samples into a single, paired-end Illumina MiSeq run. Although the amplicon regions ranged in size from approximately 290 to 720 bp, we found no significant systematic sequencing bias related to amplicon length or gene target. Our results indicate that this flexible multiplexing approach produces large, diverse, and high quality sets of amplicon sequence data for modern studies in microbial ecology. PMID:26236305

Point-of-care ultrasonography as a training milestone for internal medicine residents: the time is now.

PubMed

Sabath, Bruce F; Singh, Gurkeerat

2016-01-01

Point-of-care (POC) ultrasonography is considered fundamental in emergency medicine training and recently has become a milestone in critical care fellowship programs as well. Currently, there is no such standard requirement for internal medicine residency programs in the United States. We present a new case and briefly review another case at our institution - a community hospital - in which internal medicine house staff trained in ultrasonography were able to uncover unexpected and critical diagnoses that significantly changed patient care and outcomes. We also review the growing evidence of the application of ultrasound in the diagnosis of a myriad of conditions encountered in general internal medicine as well as the mounting data on the ability of internal medicine residents to apply this technology accurately at the bedside. We advocate that the literature has sufficiently established the role of POC ultrasonography in general internal medicine that there should no longer be any delay in giving this an official place in the development of internal medicine trainees. This may be particularly useful in the community hospital setting where 24-h echocardiography or other sonography may not be readily available.

Health status, stress and life satisfaction in a community population with MS.

PubMed

Patten, Scott B; Williams, Jeanne V A; Lavorato, Dina H; Berzins, Sandy; Metz, Luanne M; Bulloch, Andrew G M

2012-03-01

Community-based studies can describe health status and related variables in people with Multiple Sclerosis (MS) while avoiding biases introduced by help-seeking in specific clinical settings. To describe general health status, stress perceptions and life satisfaction in people with MS, in comparison to those with other types of disabilities. The Participation and Activity Limitation Survey (PALS) was a post-censual survey conducted by Statistics Canada in association with the 2006 Canadian Census. PALS collected data from a random sample of n = 22,513 respondents identified as having health-related impairments. Frequencies and quartiles as well as mean values, along with associated 95% confidence intervals, were calculated in the analysis. PALS identified 245 individuals with MS. Health status, both perceived and when weighted for societal preference, was markedly lower than that of other disabled groups. No differences in self-perceived stress were seen. People with MS reported lower levels of satisfaction with their health but slightly higher levels of satisfaction with their family and friends. People with MS report lower levels of general health status and more impairment than those with other disabling conditions. Higher levels of satisfaction with friends and family may reflect psychological adaptation to the illness.

Health Care Human Factors/Ergonomics Fieldwork in Home and Community Settings

PubMed Central

Valdez, Rupa S.; Holden, Richard J.

2017-01-01

Feature at a glance Designing innovations aligned with patients’ needs and workflow requires human factors and ergonomics (HF/E) fieldwork in home and community settings. Fieldwork in these extra-institutional settings is challenged by a need to balance the occasionally competing priorities of patient and informal caregiver participants, study team members, and the overall project. We offer several strategies that HF/E professionals can use before, during, and after home and community site visits to optimize fieldwork and mitigate challenges in these settings. Strategies include interacting respectfully with participants, documenting the visit, managing the study team-participant relationship, and engaging in dialogue with institutional review boards. PMID:28781512

Jog Your Mind: methodology and challenges of conducting evaluative research in partnership with community organizations.

PubMed

Bier, Nathalie; Lorthios-Guilledroit, Agathe; Nour, Kareen; Parisien, Manon; Ellemberg, Dave; Laforest, Sophie

2015-01-01

Jog Your Mind is a community-based program aiming at empowering elderly people to maintain their cognitive abilities using a multi-strategic approach including cognitively stimulating activities, mnemonic strategies, and strategies to promote healthy behaviors. It is offered to elderly individuals without known or diagnosed cognitive impairment by volunteers or community practitioners over ten weekly sessions. This paper describes the protocol of a quasi-experimental study designed to evaluate Jog Your Mind. Community responsible to recruit participants were either assigned to the experimental group (participating in the Jog Your Mind program) or to the control group (one-year waiting list). All participants were interviewed at baseline (T1), after the program (T2), and 12 months after the baseline (T3). Primary outcomes were the use of everyday memory strategies and aids and subjective memory functioning in daily life. Secondary outcomes included attitudes, knowledge, and behaviors related to cognitive vitality and cognitive abilities (memory and executive functions). Program delivery, organizational and environmental variables were recorded to document the implementation process. Twenty-three community organizations recruited 294 community-dwelling elderly individuals in total at T1. Between T1 and T3, an attrition rate of 15.2% was obtained. Jog Your Mind is one of the only programs targeting cognition among older adults being offered in community settings by community practitioners. The protocol described was designed with a focus on maximizing broad generalizations of the results while achieving scientific rigor. It can serve as an example to guide future research aiming to evaluate health interventions under natural conditions.

Primary care physicians’ perspectives on facilitating older patients’ access to community support services

PubMed Central

Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Lam, Annie

2017-01-01

Abstract Objective To understand how family physicians facilitate older patients’ access to community support services (CSSs) and to identify similarities and differences across primary health care (PHC) models. Design Qualitative, multiple-case study design using semistructured interviews. Setting Four models of PHC delivery, specifically 2 family health teams (FHTs), 4 non-FHTs family health organizations, 4 fee-for-service practices, and 2 community health centres in urban Ontario. Participants Purposeful sampling of 23 family physicians in solo and small and large group practices within the 4 models of PHC. Methods A multiple-case study approach was used. Semistructured interviews were conducted and data were analyzed using within- and cross-case analysis. Case study tactics to ensure study rigour included memos and an audit trail, investigator triangulation, and the use of multiple, rather than single, case studies. Main findings Three main themes were identified: consulting and communicating with the health care team to create linkages; linking patients and families to CSSs; and relying on out-of-date resources and ineffective search strategies for information on CSSs. All participants worked with their team members; however, those in FHTs and community health centres generally had a broader range of health care providers available to assist them. Physicians relied on home-care case managers to help make linkages to CSSs. Physicians recommended the development of an easily searchable, online database containing available CSSs. Conclusion This study shows the importance of interprofessional teamwork in primary care settings to facilitate linkages of older patients to CSSs. The study also provides insight into the strategies physicians use to link older persons to CSSs and their recommendations for change. This understanding can be used to develop resources and approaches to better support physicians in making appropriate linkages to CSSs. PMID:28115458

42 CFR 441.710 - State plan home and community-based services under section 1915(i)(1) of the Act.

Code of Federal Regulations, 2014 CFR

2014-10-01

... section. (1) Home and community-based settings must have all of the following qualities, and such other qualities as the Secretary determines to be appropriate, based on the needs of the individual as indicated... work in competitive integrated settings, engage in community life, control personal resources, and...