The economic benefit for family/general medicine practices employing physician assistants.

PubMed

Grzybicki, Dana M; Sullivan, Paul J; Oppy, J Miller; Bethke, Anne-Marie; Raab, Stephen S

2002-07-01

To measure the economic benefit of a family/general medicine physician assistant (PA) practice. Qualitative description of a model PA practice in a family/general medicine practice office setting, and comparison of the financial productivity of a PA practice with that of a non-PA (physician-only) practice. The study site was a family/general medicine practice office in southwestern Pennsylvania. The description of PA practice was obtained through direct observation and semistructured interviews during site visits in 1998. Comparison of site practice characteristics with published national statistics was performed to confirm the site's usefulness as a model practice. Data used for PA productivity analyses were obtained from site visits, interviews, office billing records, office appointment logs, and national organizations. The PA in the model practice had a same-task substitution ratio of 0.86 compared with the supervising physician. The PA was economically beneficial for the practice, with a compensation-to-production ratio of 0.36. Compared with a practice employing a full-time physician, the annual financial differential of a practice employing a full-time PA was $52,592. Sensitivity analyses illustrated the economic benefit of a PA practice in a variety of theoretical family/general medicine practice office settings. Family/general medicine PAs are of significant economic benefit to practices that employ them.

Practices, technologies, and usage of incident management and traveler information exchange and sharing in Texas

DOT National Transportation Integrated Search

2001-12-01

In this report, researchers present a review of the practices and technologies being used in Texas for incident management and traveler information exchange and sharing. Through interviews and site visits, researchers assimilated data from the Dallas...

Women's reasons for attrition from a nurse home visiting program.

PubMed

Holland, Margaret L; Christensen, Julie J; Shone, Laura P; Kearney, Margaret H; Kitzman, Harriet J

2014-01-01

To describe mothers' reasons for leaving a home visiting program early. Qualitative descriptive study using semistructured interviews of mothers who dropped out of the Nurse-Family Partnership (NFP) and two focus groups with nurses and nurse supervisors at an NFP site. A New York State site of a NFP home visitation program for low-income new mothers designed to improve the physical and emotional care of children. Participants included 21 mothers, 8 nurses, and 3 nurse-supervisors. Semistructured interviews and focus groups were used to collect data, which were analyzed using content analysis. The program was not perceived to fit a mother's needs when she was overwhelmed with other responsibilities, the nurse did not meet her expectations, the content was not of interest, or the mother did not desire visits after the infant was born. Nurses and mothers described the need for mothers to have organizational and communication skills, such as keeping track of appointments, calling to reschedule, articulating needs, and asking for assistance. Disruptive external influences included nurse turnover and unstable living situations, including frequent moves and crowded housing. Each of these types of barriers had potential to interact with the others, creating complex combinations of challenges to retention. NFP retention might be improved by reframing program relevance to individual mothers and increasing maternal organizational and communication skill development. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Women’s Reasons for Attrition from a Nurse Home Visiting Program

PubMed Central

Holland, Margaret L.; Christensen, Julie J.; Shone, Laura P.; Kearney, Margaret H.; Kitzman, Harriet J.

2015-01-01

Objective To describe mothers’ reasons for leaving a home visiting program early. Design Qualitative descriptive study using semi-structured interviews of mothers who dropped out of the Nurse-Family Partnership (NFP) and two focus groups with nurses and nurse supervisors at an NFP site. Setting A New York State site of a NFP home visitation program for low-income new mothers designed to improve the physical and emotional care of children. Participants Participants included 21 mothers, 8 nurses, and 3 nurse-supervisors Methods Semi-structured interviews and focus groups were used to collect data, which were analyzed using content analysis. Results The program was not perceived to fit a mother’s needs when she was overwhelmed with other responsibilities, the nurse did not meet her expectations, the content was not of interest, or the mother did not desire visits after the infant was born. Nurses and mothers described need for mothers to have organizational and communication skills, such as keeping track of appointments, calling to reschedule, articulating needs, and asking for assistance. Disruptive external influences included nurse turnover and unstable living situations, including frequent moves and crowded housing. Each of these types of barriers had potential to interact with the others, creating complex combinations of challenges to retention. Conclusion NFP retention might be improved by reframing program relevance to individual mothers and increasing maternal organizational and communication skill development. PMID:24354411

Teen Pregnancy Prevention Programs: Linking Research and Practice.

ERIC Educational Resources Information Center

Johns, Marilyn J.; Moncloa, Fe; Gong, Elizabeth J.

2000-01-01

Assessments of schools and community agencies with teen pregnancy prevention programs (n=23) in three California counties were conducted using surveys, interviews, and site visits. Best practices identified included youth development programs, Involvement of family and other caring adults, and culturally appropriate and locally relevant…

High-Security Fencing for Rail Right-of-way Applications : Current Use and Best Practices.

DOT National Transportation Integrated Search

2015-10-01

The Volpe Center investigated how high-security fencing is used to prevent right-of-way (ROW) trespassing at several urban transit and commuter rail agencies in the United States. Interviews, operations documentation, and site visits were used to gat...

Factors Contributing to Institutions Achieving Environmental Sustainability

ERIC Educational Resources Information Center

James, Matthew; Card, Karen

2012-01-01

Purpose: The purpose of this paper is to determine what factors contributed to three universities achieving environmental sustainability. Design/methodology/approach: A case study methodology was used to determine how each factor contributed to the institutions' sustainability. Site visits, fieldwork, document reviews, and interviews with…

Primary Care Clinic Re-Design for Prescription Opioid Management.

PubMed

Parchman, Michael L; Von Korff, Michael; Baldwin, Laura-Mae; Stephens, Mark; Ike, Brooke; Cromp, DeAnn; Hsu, Clarissa; Wagner, Ed H

The challenge of responding to prescription opioid overuse within the United States has fallen disproportionately on the primary care clinic setting. Here we describe a framework comprised of 6 Building Blocks to guide efforts within this setting to address the use of opioids for chronic pain. Investigators conducted site visits to thirty primary care clinics across the United States selected for their use of team-based workforce innovations. Site visits included interviews with leadership, clinic tours, observations of clinic processes and team meetings, and interviews with staff and clinicians. Data were reviewed to identify common attributes of clinic system changes around chronic opioid therapy (COT) management. These concepts were reviewed to develop narrative descriptions of key components of changes made to improve COT use. Twenty of the thirty sites had addressed improvements in COT prescribing. Across these sites a common set of 6 Building Blocks were identified: 1) providing leadership support; 2) revising and aligning clinic policies, patient agreements (contracts) and workflows; 3) implementing a registry tracking system; 4) conducting planned, patient-centered visits; 5) identifying resources for complex patients; and 6) measuring progress toward achieving clinic objectives. Common components of clinic policies, patient agreements and data tracked in registries to assess progress are described. In response to prescription opioid overuse and the resulting epidemic of overdose and addiction, primary care clinics are making improvements driven by a common set of best practices that address complex challenges of managing COT patients in primary care settings. © Copyright 2017 by the American Board of Family Medicine.

Intergenerational Stories and the "Othering" of Samoan Youth in Schools

ERIC Educational Resources Information Center

Yeh, Christine J.; Borrero, Noah E.; Tito, Patsy; Petaia, Lealaisalanoa Setu

2014-01-01

Through a critical cultural assets model, the authors use the methodological practices of collaboration, community site visits, document analysis, and interviews with cultural insiders to explore schools' continued rejection of academic belonging for people from "othered" communities. They explore the case of Samoan youth--a marginalized…

Determination and prioritization of MoDOT geotechnical related problems with emphasis on effectiveness of design for bridge approach slabs and pavement edge drains

DOT National Transportation Integrated Search

2003-01-01

Surveys, interviews and site visits were used to identify, observe and document geotechnical-related problems in Missouri DOT infrastructure. Documented issues were evaluated and prioritized. Additional attention was focused on Pavement Edge Drains a...

District-Charter Collaboration Grant Implementation: Final Findings from Interviews and Site Visits. Interim Report

ERIC Educational Resources Information Center

McCullough, Moira; Keating, Betsy; Heinkel, Luke

2016-01-01

In November 2012, the Bill & Melinda Gates Foundation invested in seven innovative district-charter partnerships with "the potential capacity and commitment to accelerate student college ready rates through deep collaboration and sharing of best practices" (District-Charter Collaboration Grant Request for Proposal). These…

Evaluation Report on the Community Learning Center.

ERIC Educational Resources Information Center

Fried, Robert L.

The Community Learning Center (CLC) evaluation is based on on-site visits and interviews with staff and students of widely differing ethnic backgrounds. Teaching resources are varied. The Model Cities program is the basic source for CLC funding; the Cambridge Public Library is the center's local sponsor. The external bureaucratic framework needs…

77 FR 74516 - Notice of Intent To Seek Approval To Establish an Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-14

.... The evaluation will include surveys of principal investigators, surveys of a sample of S-STEM scholarship recipients, and focus groups and interviews with project personnel and students during site visits... academically talented students, in science and engineering disciplines, who have demonstrated financial need...

American Memory User Evaluation, 1991-1993.

ERIC Educational Resources Information Center

Veccia, Susan; And Others

This report summarizes the American Memory User Evaluation conducted during 1991-1993 in over 40 locations around the United States. The findings are based on 1800 user questionnaires, 120 user interviews, and more than 40 site visits by Library staff. American Memory describes the concept of providing electronic versions of selected Library of…

Development and Field-Test of an Instrument to Assess the Extent to Which a Vocational Educational Program Is Either Competency-Based or Conventional. Final Report from September 1, 1984 to August 31, 1985.

ERIC Educational Resources Information Center

University of Central Florida, Orlando. Coll. of Education.

This report describes the production and pilot test of an assessment instrument for vocational education programs. The instrument was designed to be used following a site visit that includes a 30- to 45-minute interview with the program instructor and a 30-minute interview with one small group of students. Reliability and validity information was…

The Info Commons Concept: Assessing User Needs

ERIC Educational Resources Information Center

Cataldo, Tara Tobin; Freund, LeiLani; Ocha, Marilyn N.; Salcedo, Marina

2006-01-01

The University of Florida Libraries took the opportunity of remodeling its Humanities and Social Sciences library to conceptualize the design of an info commons area for the new building. An Info Commons Concept Team was formed and charged with this task. The team used site visits, surveys, focus groups, and interviews to determine the needs of…

Old Dogs, New Tricks: Training Mature-Aged Manufacturing Workers

ERIC Educational Resources Information Center

Smith, Erica; Smith, Andrew; Smith, Chris Selby

2010-01-01

Purpose: This paper aims to examine the employment and training of mature-aged workers, so that suggestions for improving training for mature-aged workers may be offered. Design/methodology/approach: Six expert interviews were carried out by telephone, and three case studies involving company site visits were completed. Each company case study…

An Exploration of Contemporary Realities of Technology and Teacher Education: Lessons Learned

ERIC Educational Resources Information Center

Bakir, Nesrin

2015-01-01

In order to better prepare preservice teachers to teach with technology, this study examines the current practices and barriers in technology implementation in three teacher education programs. This multiple-case study relied upon site visits, observations, in-depth interviews with faculty, staff, and preservice teachers, and examinations of…

Pedagogical Strategies for Work-Based Learning. IEE Working Paper No. 12.

ERIC Educational Resources Information Center

Hughes, Katherine L.; Moore, David Thornton

Fourteen school-to-work programs characterized by strong work-based learning components and solid employer involvement were examined in a 3-year study to identify pedagogical factors associated with successful work-based learning programs. The main data collection activities were as follows: site visits to the 15 programs to interview faculty,…

Improving Outcomes for Students with Disabilities: Identifying Characteristics of Successful Districts

ERIC Educational Resources Information Center

DeVries, Melissa; Tkatchov, Oran

2017-01-01

The common characteristics among Arizona districts and charters with high academic outcomes for student disabilities were identified in a qualitative study involving site visits and interviews. In 2014, the Arizona Department of Education examined over three years of state testing data to identify districts and charter schools that closed the…

LANDFILL GAS ENERGY UTILIZATION EXPERIENCE: DISCUSSION OF TECHNICAL AND NON-TECHNICAL ISSUES, SOLUTIONS, AND TRENDS

EPA Science Inventory

The report discusses technical and non-technical considerations associated with the development and operation of landfill gas to energy projects. Much of the report is based on interviews and site visits with the major developers and operators of the more than 110 projects in the...

Civic Space/Cyberspace: The American Public Library in the Information Age.

ERIC Educational Resources Information Center

Molz, Redmond Kathleen; Dain, Phyllis

This book assesses the current condition and direction of the American public library. It considers the challenges and opportunities presented by new electronic technologies, changing public policy, fiscal realities, and cultural trends. The authors draw on site visits and interviews conducted across the country, as well as extensive reading of…

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

PubMed

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

2001-10-08

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

The Plastic Surgery Match: A Quantitative Analysis of Applicant Impressions From the Interview Visit.

PubMed

Frojo, Gianfranco; Tadisina, Kashyap Komarraju; Pressman, Zachary; Chibnall, John T; Lin, Alexander Y; Kraemer, Bruce A

2016-12-01

The integrated plastic surgery match is a competitive process not only for applicants but also for programs vying for highly qualified candidates. Interactions between applicants and program constituents are limited to a single interview visit. The authors aimed to identify components of the interview visit that influence applicant decision making when determining a final program rank list. Thirty-six applicants who were interviewed (100% response) completed the survey. Applicants rated the importance of 20 elements of the interview visit regarding future ranking of the program on a 1 to 5 Likert scale. Data were analyzed using descriptive statistics, hierarchical cluster analysis, analysis of variance, and Pearson correlations. A literature review was performed regarding the plastic surgery integrated residency interview process. Survey questions were categorized into four groups based on mean survey responses:1. Interactions with faculty and residents (mean response > 4),2. Information about the program (3.5-4),3. Ancillaries (food, amenities, stipends) (3-3.5),4. Hospital tour, hotel (<3).Hierarchical item cluster analysis and analysis of variance testing validated these groupings. Average summary scores were calculated for the items representing Interactions, Information, and Ancillaries. Correlation analysis between clusters yielded no significant correlations. A review of the literature yielded a paucity of data on analysis of the interview visit. The interview visit consists of a discrete hierarchy of perceived importance by applicants. The strongest independent factor in determining future program ranking is the quality of interactions between applicants and program constituents on the interview visit. This calls for further investigation and optimization of the interview visit experience.

Involving Employers in Training: Case Studies. Research and Evaluation Report Series 97-J.

ERIC Educational Resources Information Center

Isbell, Kellie; Trutko, John W.; Barnow, Burt S.; Nightengale, Demetra; Pindus, Nancy

This document contains in-depth descriptions and assessments of 17 exemplary employer-based training (EBT) programs that were studied as part of an examination of EBT programs. The case studies are based on site visits to each firm, during which interviews were conducted with company management, supervisors of workers in training, individuals…

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

ERIC Educational Resources Information Center

Keegan, Sinead; Chaplin, Duncan

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

Accolades and Recommendations: A Longitudinal Analysis of Monitoring Reports for Two Charter Schools Serving Native American Students

ERIC Educational Resources Information Center

Anderson, Derek L.; Holder, K. C.

2012-01-01

This longitudinal case study examines 10 years' worth of annual monitoring reports for two rural Native American Charter Schools. Using data from multiple sources including interviews, site visits, and document analyses, the authors used provisional coding and constant comparison analysis to categorize the accolades and recommendations embedded in…

Partnerships for Change. Research.

ERIC Educational Resources Information Center

David, Jane L.

Based on visits to four Apple Classrooms of Tomorrow (ACOT) sites in the spring of 1990 and interviews with Apple ACOT staff, this paper represents the first round of a 3-year study for Apple Computer, Inc., about the role of ACOT in educational restructuring. An overview of the ACOT project is presented, and the evolution and structure of ACOT…

Trust Territory of the Pacific Islands Adult Basic Education Program. Evaluation Report, Fiscal Year 1979.

ERIC Educational Resources Information Center

McCune, Donald A.

The Adult Basic Education (ABE) program conducted by the Trust Territory of the Pacific Islands was evaluated. Data were collected via staff interviews and record reviews during site visits at ABE facilities located in five of six district comprising the Trust Territory. Focus of the evaluation activities was on program administration,…

The State of Libraries in Solomon Islands in the 1990s.

ERIC Educational Resources Information Center

Dadalo, Tony

The purpose of this research project was to examine the current state of libraries in the Solomon Islands with particular attention to the resources available and the services provided. Data was collected through a survey questionnaire, site visits, and informal interviews carried out in the Solomon Islands between July and August 1998. The 20…

Day Care in Alberta, Canada: Overcoming the Barriers for Children with Disabilities. Working Paper Series, No. 231.

ERIC Educational Resources Information Center

Fink, Dale Borman

This study of integrated day care in the province of Alberta, Canada, involved observations and interviews at preschool sites in Calgary and Edmonton. The discussion resulting from the Calgary visits considers: combining funding from a provincial agency with the availability of hospital-sponsored mobile clinical services to support integration in…

Design of evidence-based gardens and garden therapy for neurodisability in Scandinavia: data from 14 sites.

PubMed

Spring, Josephine Anne

2016-04-01

A total of 14 Scandinavian therapy gardens were visited and data collected on plantings, therapeutic activities and assessment of effectiveness in Spring 2014. Data were gathered by a questionnaire and by interviewing staff in Sweden, Denmark and Norway. The data collection structured proforma used the post-occupation assessment method. Gardening promoted physical movement, presented cognitive challenges and provided opportunities for social participation. Half the gardens were enclosed with sensory plants and 85% were adapted for wheelchairs. A total of 57% of gardens visited had simple designs with flowers, shrubs, lawns and trees. A social center was important especially for dementia clients. Planted pots were used in 79% of gardens. The effectiveness of therapy gardens was assessed at 71% of sites.

Identifying and assessing ecotourism visitor impacts at selected protected areas in Costa Rica and Belize

USGS Publications Warehouse

Farrell, T.A.; Marion, J.L.

2001-01-01

Protected area visitation is an important component of ecotourism, and as such, must be sustainable. However, protected area visitation may degrade natural resources, particularly in areas of concentrated visitor activities like trails and recreation sites. This is an important concern in ecotourism destinations such as Belize and Costa Rica, because they actively promote ecotourism and emphasize the pristine qualities of their natural resources. Research on visitor impacts to protected areas has many potential applications in protected area management, though it has not been widely applied in Central and South America. This study targeted this deficiency through manager interviews and evaluations of alternative impact assessment procedures at eight protected areas in Belize and Costa Rica. Impact assessment procedures included qualitative condition class systems, ratings systems, and measurement-based systems applied to trails and recreation sites. The resulting data characterize manager perceptions of impact problems, document trail and recreation site impacts, and provide examples of inexpensive, efficient and effective rapid impact assessment procedures. Interview subjects reported a variety of impacts affecting trails, recreation sites, wildlife, water, attraction features and other resources. Standardized assessment procedures were developed and applied to record trail and recreation site impacts. Impacts affecting the study areas included trail proliferation, erosion and widening, muddiness on trails, vegetation cover loss, soil and root exposure, and tree damage on recreation sites. The findings also illustrate the types of assessment data yielded by several alternative methods and demonstrate their utility to protected area managers. The need for additional rapid assessment procedures for wildlife, water, attraction feature and other resource impacts was also identified.

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

PubMed

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

2006-01-01

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

28 CFR 543.13 - Visits by attorneys.

Code of Federal Regulations, 2010 CFR

2010-07-01

... interview. If there is any question about the identity of the visitor or his qualification as an attorney in... an attorney who wishes to interview an inmate as a witness. (b) The Warden generally may not limit... to visit an inmate who has requested his visit or whom he represents or whom he wishes to interview...

28 CFR 543.13 - Visits by attorneys.

Code of Federal Regulations, 2011 CFR

2011-07-01

... interview. If there is any question about the identity of the visitor or his qualification as an attorney in... an attorney who wishes to interview an inmate as a witness. (b) The Warden generally may not limit... to visit an inmate who has requested his visit or whom he represents or whom he wishes to interview...

Evidence-informed health policy 4 – Case descriptions of organizations that support the use of research evidence

PubMed Central

Lavis, John N; Moynihan, Ray; Oxman, Andrew D; Paulsen, Elizabeth J

2008-01-01

Background Previous efforts to produce case descriptions have typically not focused on the organizations that produce research evidence and support its use. External evaluations of such organizations have typically not been analyzed as a group to identify the lessons that have emerged across multiple evaluations. Case descriptions offer the potential for capturing the views and experiences of many individuals who are familiar with an organization, including staff, advocates, and critics. Methods We purposively sampled a subgroup of organizations from among those that participated in the second (interview) phase of the study and (once) from among other organizations with which we were familiar. We developed and pilot-tested a case description data collection protocol, and conducted site visits that included both interviews and documentary analyses. Themes were identified from among responses to semi-structured questions using a constant comparative method of analysis. We produced both a brief (one to two pages) written description and a video documentary for each case. Results We conducted 51 interviews as part of the eight site visits. Two organizational strengths were repeatedly cited by individuals participating in the site visits: use of an evidence-based approach (which was identified as being very time-consuming) and existence of a strong relationship between researchers and policymakers (which can be challenged by conflicts of interest). Two organizational weaknesses – a lack of resources and the presence of conflicts of interest – were repeatedly cited by individuals participating in the site visits. Participants offered two main suggestions for the World Health Organization (and other international organizations and networks): 1) mobilize one or more of government support, financial resources, and the participation of both policymakers and researchers; and 2) create knowledge-related global public goods. Conclusion The findings from our case descriptions, the first of their kind, intersect in interesting ways with the messages arising from two systematic reviews of the factors that increase the prospects for research use in policymaking. Strong relationships between researchers and policymakers bodes well given such interactions appear to increase the prospects for research use. The time-consuming nature of an evidence-based approach, on the other hand, suggests the need for more efficient production processes that are 'quick and clean enough.' Our case descriptions and accompanying video documentaries provide a rich description of organizations supporting the use of research evidence, which can be drawn upon by those establishing or leading similar organizations, particularly in low- and middle-income countries. PMID:19091110

Installation-restoration program. Preliminary assessment: 106th Civil Engineering Flight, Roslyn Air National Guard Station, New York Air National Guard, Roslyn, New York

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

Not Available

1991-02-01

The preliminary assessment included the following activities: (1) An on-site visit, including interviews and field surveys; (2) Acquisition and analysis of information on past hazardous materials use, waste generation, and waste disposal at the Station; (3) Acquisition and analysis of available geological surveys, hydrological data, meteorological data, and environmental data; and (4) The identification and assessment of sites where contamination of soils, ground water and/or surface water may have occurred. Operations that have involved the use of hazardous materials and the disposal of hazardous wastes include vehicle maintenance and aerospace ground equipment (AGE) maintenance. The hazardous wastes disposed fo throughmore » these operations include varying quantities of petroleum-oil-lubricant (POL) products, acids, paints, thinners, strippers, and solvents. The field surveys and interviews resulted in the identification of three sites that exhibit the potential for migration of contaminants.« less

Redesign of the Pollution Abatement Costs and Expenditures (PACE) Survey: Findings and Recommendations from Pretest and Follow-up; and MA-200 Survey and Instructions (2006)

EPA Pesticide Factsheets

First phase: redesigning the survey included three key activities 1) consultation with an expert panel,2) on-site visits with four facilities; and 3) one-on-one interviews. Second phase included a pretest and pilot of the 2004 PACE survey form and guidance

Going On-line. A Research Report on the Use of On-line Technologies by Adult Literacy Teachers and Learners.

ERIC Educational Resources Information Center

Victoria Univ. of Tech., Melbourne (Australia).

The Literacy Learning through Technology project sought to explore how professionals in adult literacy and basic education (ALBE) in Victoria, Australia, developed their expertise with online technology and incorporated it into their programs. Data were gathered from surveys and follow-up interviews with 10 participants and visits to 9 sites that…

Third-Party Final Report of the Ohio State Department of Education's EBCE 3-Year Project.

ERIC Educational Resources Information Center

Rusling, Diane E.

Six school sites were visited to evaluate the work being done there in the third and final year of the Ohio Experience-Based Career Education program (EBCE) for secondary students (primarily 9th and 10th graders). Evaluators interviewed school staff, present and former EBCE participants, and employers in the communities. Questionnaires were also…

Capital Area Education and Careers Partnership School-to-Career Grant: An Assessment of Early Accomplishments, Constraints and Prospects.

ERIC Educational Resources Information Center

O'Shea, Daniel P.; King, Christopher T.

The activities and services delivered under the School-to-Work Opportunities Act of 1994 by the Capital Area Education and Careers Partnership in Austin, Texas, during 1998 and 1999 were evaluated by an independent evaluator, using interviews with 24 persons involved in the project, site visits, and document analysis. The evaluation found that…

Evaluating Administrators with Portfolios: Principals Report Mostly Positive Experiences when Used as Part of a Performance Review

ERIC Educational Resources Information Center

Russo, Alexander

2004-01-01

Simple checklists, one-shot interviews, brief site visits and narrative evaluations remain widespread as the tools of assessment. In many school districts, the evaluation includes little or no face-to-face contact, and the principal simply gets his or her evaluation in the mail, leading one researcher to describe them as "infrequent, late,…

Rural Palliative Care in North India: Rapid Evaluation of a Program Using a Realist Mixed Method Approach.

PubMed

Munday, Daniel F; Haraldsdottir, Erna; Manak, Manju; Thyle, Ann; Ratcliff, Cathy M

2018-01-01

Palliative care has not developed widely in rural North India. Since 2010, the Emmanuel Hospitals Association (EHA) has been developing a model of palliative care appropriate for this setting, based on teams undertaking home visits with the backup of outpatient and inpatient services. A project to further develop the model operated from 2012 to 2015 supported by funding from the UK. This study aims to evaluate the EHA palliative care project. Rapid evaluation method using a mixed method realist approach at the five project hospital sites. An overview of the project was obtained by analyzing project documents and key informant interviews. Questionnaire data from each hospital were collected, followed by interviews with staff, patients, and relatives and observations of home visits and other activities at each site. Descriptive analysis of quantitative and thematic analysis of qualitative data was undertaken. Each site was measured against the Indian Minimum Standards Tool for Palliative Care (IMSTPC). Each team followed the EHA model, with local modifications. Services were nurse led with medical support. Eighty percent of patients had cancer. Staff demonstrated good palliative care skills and patients and families appreciated the care. Most essential IMSTPC markers were achieved but morphine licenses were available to only two teams. Remarkable synergy was emerging between palliative care and community health. Hospitals planned to fund palliative care through income from surgical services. Excellent palliative care appropriate for rural north India is delivered through the EHA model. It could be extended to other similar sites.

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

PubMed

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

2015-03-01

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

Kenya Quaker Secondary School Peace Curriculum Pilot Project: Examining the Role of the Principal in the Successes and Challenges of the Implementation

ERIC Educational Resources Information Center

Hockett, Eloise

2015-01-01

This qualitative study examined the implementation of a peace curriculum for Kenyan Quaker secondary schools. Fourteen schools were selected for this study 1 year after school leaders attended specific training sessions. On site visits were made to 12 of the 14 schools selected for this study, and interviews conducted with the remaining…

Analysis of a Field Study: Programs, Services, and Approaches Toward the Reduction of Adolescent Pregnancy. Final Report.

ERIC Educational Resources Information Center

Moore, Audrey

This field survey relative to adolescent pregnancy was undertaken through site visits and interviews. Data indicated that: (1) while many people are carrying out excellent programs and activities, the numbers are small compared to the need; (2) in some types of services the old tried-and-found-wanting approaches are perpetuated; (3) in some,…

A preliminary analysis of environmental dilemmas and environmental ethical reasoning among Hispanic and non-Hispanic forest visitors

Treesearch

Thomas C. Swearingen; Robert E. Pfister

1995-01-01

In a preliminary investigation of environmental reasoning, Hispanic and Anglo-American visitors were interviewed during the summer of 1991 in two National Forests near Los Angeles. A bilingual research technician approached parties visiting the sample sites and, after a brief introduction, requested that they participate in the study. No more than two persons from each...

Helping the auto repair industry manage hazardous wastes: an education project in King County, Washington.

PubMed

McKenrick, Laurence L; Ii, Keiko; Lawrence, Bill; Kaufmann, Michael; Marshall, Mark

2003-11-01

From January 1, 2000, to August 31, 2001, a team of environmental health specialists from Public Health-Seattle & King County, a partner in King County's Local Hazardous Waste Management Program, made educational visits to 981 automotive repair shops. The purpose was to give the auto repair industry technical assistance on hazardous waste management without using enforcement action. Through site inspections and interviews, the environmental health staff gathered information on the types and amounts of conditionally exempt small-quantity generator (CESQG) hazardous wastes and how they were handled. Proper methods of hazardous waste management, storage, and disposal were discussed with shop personnel. The environmental health staff measured the impact of these educational visits by noting changes made between the initial and follow-up visits. This report focuses on nine major waste streams identified in the auto repair industry. Of the 981 shops visited, 497 were already practicing proper hazardous waste management and disposal. The remaining 484 shops exhibited 741 discrepancies from proper practice. Environmental health staff visited these shops again within six months of the initial visit to assess changes in their practices. The educational visits and technical assistance produced a 76 percent correction of all the discrepancies noted.

Air Quality Management Alternatives: United States Air Force Firefighter Training Facilities

DTIC Science & Technology

1988-01-01

Pollution at LAX, JFK , and ORD," Impact of Aircraft Emissions on Air Quality in the Vicinity of Airports , Volume II, FAA-EE-80-09B, Federal...developed and applied . This method enabled fire prevention, and environmental management experts and professionals to provide data, opinions, and to...methodology utilizing questionnaires, interviews, and site visits is developed and applied . This method enabled fire prevention, and environmental

Camp for all connection: a community health information outreach project.

PubMed

Huber, Jeffrey T; Walsh, Teresa J; Varman, Beatriz

2005-07-01

The purpose of the Camp For All Connection project is to facilitate access to electronic health information resources at the Camp For All facility. Camp For All is a barrier-free camp working in partnership with organizations to enrich the lives of children and adults with chronic illnesses and disabilities and their families by providing camping and retreat experiences. The camp facility is located on 206 acres in Burton, Texas. The project partners are Texas Woman's University, Houston Academy of Medicine-Texas Medical Center Library, and Camp For All. The Camp For All Connection project placed Internet-connected workstations at the camp's health center in the main lodge and provided training in the use of electronic health information resources. A train-the-trainer approach was used to provide training to Camp For All staff. Project workstations are being used by health care providers and camp staff for communication purposes and to make better informed health care decisions for Camp For All campers. A post-training evaluation was administered at the end of the train-the-trainer session. In addition, a series of site visits and interviews was conducted with camp staff members involved in the project. The site visits and interviews allowed for ongoing dialog between project staff and project participants.

Unlicensed care homes in the United States: a clandestine sector of long-term care.

PubMed

Lepore, Michael; Greene, Angela M; Porter, Kristie; Lux, Linda; Vreeland, Emily; Hawes, Catherine

2018-06-11

Residential care facilities operating without a state license are known to house vulnerable adults. Such unlicensed care homes (UCHs) commonly operate illegally, making them difficult to investigate. We conducted an exploratory, multimethod qualitative study of UCHs, including 18 subject matter expert interviews and site visits to three states, including a total of 30 stakeholder interviews, to understand UCH operations, services provided, and residents served. Findings indicate that various vulnerable groups reside in UCHs; some UCHs offer unsafe living environments; and some residents are reportedly abused, neglected, and financially exploited. Regulations, policies and practices that might influence UCH prevalence are discussed.

Installation-restoration program. Preliminary assessment: 201st Red Horse, Civil Engineering Flight, Fort Indiantown Gap Air National Guard Station, Pennsylvania Air National Guard, Annville, Pennsylvania

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

Not Available

1991-02-01

The preliminary assessment included the following activities: (1) An on-site visit, including interviews and field surveys; (2) Acquisition and analysis of information on past hazardous materials use, waste generation, and waste disposal at the Station; (3) Acquisition and analysis of available geological surveys, hydrological data, meteorological data, and environmental data; and (4) The identification and assessment of sites where contamination of soils, ground water and/or surface water may have occurred. Operations that have involved the use of hazardous materials and the disposal of hazardous wastes include vehicle maintenance and aerospace ground equipment (AGE) maintenance. The hazardous wastes disposed of throughmore » these operations include varying quantities of petroleum-oil-lubricant (POL) products, acids, paints, thinners, strippers, and solvents. The field surveys and interviews resulted in the identification of three sites that exhibit the potential for migration of contaminants due to leakage or seepage from landfills and storage tanks.« less

Preceptor Perceptions of Virtual Quality Assurance Experiential Site Visits.

PubMed

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

2018-05-01

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

The Association of Health Literacy With Preventable Emergency Department Visits: A Cross-sectional Study.

PubMed

Balakrishnan, Meenakshi P; Herndon, Jill Boylston; Zhang, Jingnan; Payton, Thomas; Shuster, Jonathan; Carden, Donna L

2017-09-01

Policymakers argue that emergency department (ED) visits for conditions preventable with high-quality outpatient care contribute to waste in the healthcare system. However, access to ambulatory care is uneven, especially for vulnerable populations like minorities, the poor, and those with limited health literacy. The impact of limited health literacy on ED visits that are preventable with timely, high-quality ambulatory care is unknown. The objective was to determine the association of health literacy with preventable ED visits. We conducted an observational cross-sectional study of potentially preventable ED visits (outcome) among adults (≥18 years old) in an ED serving an urban community. We assessed health literacy (predictor) through structured interviews with the Rapid Estimate of Adult Literacy in Medicine (REALM). We recorded age, sex, race, employment, payer, marital and health status, and number of comorbidities through structured interviews or electronic record review. We identified potentially preventable ED visits in the 2 years before the index ED visit by applying Agency for Healthcare Research and Quality technical specifications to identify ambulatory care sensitive conditions using ED discharge diagnoses in hospital administrative data. We used Poisson regression to evaluate the number of preventable ED visits among patients with limited (REALM < 61) versus adequate (REALM ≥ 61) health literacy after adjusting for covariates. Of 1,201 participants, 709 (59%) were female, 370 (31%) were African American, mean age was 41.6 years, and 394 (33%) had limited health literacy. Of 4,444 total ED visits, 423 (9.5%) were potentially preventable. Of these, 260 (61%) resulted in hospital admission and 163 (39%) were treat and release. After covariates were adjusted for, patients with limited literacy had 2.3 (95% confidence interval [CI] = 1.7-3.1) times the number of potentially preventable ED visits resulting in hospital admission compared to individuals with adequate health literacy, 1.4 (95% CI = 1.0-2.0) times the number of treat-and-release visits, and 1.9 (95% CI = 1.5-2.4) times the number of total preventable ED visits. Our results suggest that the ED may be an important site to deploy universal literacy-sensitive precautions and to test literacy-sensitive interventions with the goal of reducing the burden of potentially preventable ED visits on patients and the healthcare system. © 2017 by the Society for Academic Emergency Medicine.

Governance for clinical decision support: case studies and recommended practices from leading institutions

PubMed Central

Sittig, Dean F; Ash, Joan S; Bates, David W; Feblowitz, Joshua; Fraser, Greg; Maviglia, Saverio M; McMullen, Carmit; Nichol, W Paul; Pang, Justine E; Starmer, Jack; Middleton, Blackford

2011-01-01

Objective Clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technical governance structures. The authors sought to determine the range and variety of these governance structures and identify a set of recommended practices through observational study. Design Three site visits were conducted at institutions across the USA to learn about CDS capabilities and processes from clinical, technical, and organizational perspectives. Based on the results of these visits, written questionnaires were sent to the three institutions visited and two additional sites. Together, these five organizations encompass a variety of academic and community hospitals as well as small and large ambulatory practices. These organizations use both commercially available and internally developed clinical information systems. Measurements Characteristics of clinical information systems and CDS systems used at each site as well as governance structures and content management approaches were identified through extensive field interviews and follow-up surveys. Results Six recommended practices were identified in the area of governance, and four were identified in the area of content management. Key similarities and differences between the organizations studied were also highlighted. Conclusion Each of the five sites studied contributed to the recommended practices presented in this paper for CDS governance. Since these strategies appear to be useful at a diverse range of institutions, they should be considered by any future implementers of decision support. PMID:21252052

Home visiting programs for HIV-affected families: a comparison of service quality between volunteer-driven and paraprofessional models.

PubMed

Kidman, Rachel; Nice, Johanna; Taylor, Tory; Thurman, Tonya R

2014-10-02

Home visiting is a popular component of programs for HIV-affected children in sub-Saharan Africa, but its implementation varies widely. While some home visitors are lay volunteers, other programs invest in more highly trained paraprofessional staff. This paper describes a study investigating whether additional investment in paraprofessional staffing translated into higher quality service delivery in one program context. Beneficiary children and caregivers at sites in KwaZulu-Natal, South Africa were interviewed after 2 years of program enrollment and asked to report about their experiences with home visiting. Analysis focused on intervention exposure, including visit intensity, duration and the kinds of emotional, informational and tangible support provided. Few beneficiaries reported receiving home visits in program models primarily driven by lay volunteers; when visits did occur, they were shorter and more infrequent. Paraprofessional-driven programs not only provided significantly more home visits, but also provided greater interaction with the child, communication on a larger variety of topics, and more tangible support to caregivers. These results suggest that programs that invest in compensation and extensive training for home visitors are better able to serve and retain beneficiaries, and they support a move toward establishing a professional workforce of home visitors to support vulnerable children and families in South Africa.

8 CFR 204.311 - Convention adoption home study requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... individual has one), and date of birth. (3) Include an interview by the preparer of any additional adult... paragraph (f) of this section. (7) State the number of interviews and visits, the participants, date and location of each interview and visit, and the date and location of any other contacts with the applicant...

8 CFR 204.311 - Convention adoption home study requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... individual has one), and date of birth. (3) Include an interview by the preparer of any additional adult... paragraph (f) of this section. (7) State the number of interviews and visits, the participants, date and location of each interview and visit, and the date and location of any other contacts with the applicant...

Infusing Technology Into Perinatal Home Visitation in the United States for Women Experiencing Intimate Partner Violence: Exploring the Interpretive Flexibility of an mHealth Intervention

PubMed Central

Bullock, Linda; Sharps, Phyllis; Burnett, Camille; Schminkey, Donna L; Buller, Ana Maria; Campbell, Jacquelyn

2016-01-01

Background Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored. Objective Our objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors’ and women’s perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method. Methods We used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the 2 DOVE program designers. Nonparticipant observations of home visits with trial participants who chose not to participate in semistructured interviews were undertaken. Results We conducted 51 interviews with 26 women, 23 home visiting staff at rural and urban sites, and the 2 DOVE program designers. We conducted 4 nonparticipant observations. Among 18 IPV-positive women, 7 used the computer tablet and 11 used the home visitor method. Among 8 IPV-negative women, 7 used the home visitor method. The computer tablet was viewed as a safe and confidential way for abused women to disclose their experiences without fear of being judged. The meanings that the DOVE technology held for home visitors and women led to its construction as either an impersonal artifact that was an impediment to discussion of IPV or a conduit through which interpersonal connection could be deepened, thereby facilitating discussion about IPV. Women’s and home visitors’ comfort with either method of screening was positively influenced by factors such as having established trust and rapport, as well as good interpersonal communication. The technology helped reduce the anticipated stigma associated with disclosing abuse. The didactic intervention video was a limiting feature, as the content could not be tailored to accommodate the fluidity of women’s circumstances. Conclusions Users and developers of technology-based IPV interventions need to consider the context in which they are being embedded and the importance of the patient-provider relationship in promoting behavior change in order to realize the full benefits. An mHealth approach can and should be used as a tool for initiating discussion about IPV, assisting women in enhancing their safety and exploring help-seeking options. However, training for home visitors is required to ensure that a computer tablet is used to complement and enhance the therapeutic relationship. ClinicalTrial Clinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitation.org/6limSWdZP) PMID:27856405

Effects of aircraft overflights on wilderness recreationists.

PubMed

Fidell, S; Silvati, L; Howe, R; Pearsons, K S; Tabachnick, B; Knopf, R C; Gramann, J; Buchanan, T

1996-11-01

On-site and telephone opinion surveys were conducted to assess outdoor recreationists' annoyance with aircraft overflights of wilderness areas. Although current technology for measuring noise exposure does not yet permit accurate and cost-effective estimates of dosage-response relationships in outdoor recreational settings, it was nonetheless possible to construct a rough relationship between estimated aircraft noise exposure and annoyance from the data of the on-site study. In the second survey, telephone interviews were administered to another sample of outdoor recreationists within 2 weeks of their return from visits to 12 wilderness areas. The prevalence of aircraft noise-induced annoyance (in any degree) among respondents in all wilderness areas ranged from 5% to 32%. The prevalence of a consequential degree of aircraft noise-induced annoyance among respondents was less than 5% in all wilderness areas combined. Noise-induced annoyance proved to be a more direct measure of the effects of aircraft overflights on recreationists than more global measures such as visit satisfaction or intent to revisit.

Welfare Reform: With TANF Flexibility, States Vary in How They Implement Work Requirements and Time Limits. Report to the Chairman, Subcommittee on Human Resources, Committee on Ways and Means, House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC.

In this report, the General Accounting Office (GAO) examined how different states are implementing the work requirements and time limits called for by the Temporary Assistance for Needy Families (TANF) program. Data were collected from site visits in 4 states, telephone interviews with TANF officials in 8 additional states, and a survey…

A Cost Benefit Analysis of Radio Frequency Identification (RFID) Implementation at the Naval Postgraduate School’s Dudley Knox Library

DTIC Science & Technology

2006-12-01

anecdotal. Even a study of California libraries conducted by Engel, which aimed primarily at providing guidance to future users by surveying the...only. This study has both quantitative and qualitative analyses. A Cost Benefit Analysis (CBA) was conducted using data gathered from research which...included personal interviews, site visits, and a survey questionnaire. Time and motion studies of selected library processes were conducted at DKL

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

PubMed

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

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

'I felt a little bubbly in my tummy': eliciting pre-schoolers' accounts of their health visit using a computer-assisted interview method.

PubMed

Bokström, P; Fängström, K; Calam, R; Lucas, S; Sarkadi, A

2016-01-01

In the health care services, children's rights to participate in all matters that concern them are considered important. However, in practice this can be challenging with young children. In My Shoes (IMS) is a computer-assisted interview tool developed to help children talk about their experiences. The aim of the study was to evaluate the IMS' ability to elicit pre-schoolers' subjective experiences and accurate accounts of a routine health visit as well as the children's engagement in the interview process. Interviews were conducted with 23 children aged 4-5 years, 2-4 weeks after their health visit. The interviews were transcribed verbatim and analysed using a method inspired by Content Analysis to evaluate IMS's ability to elicit accounts about subjective experiences. Accurate accounts were assessed by comparing the transcribed interviews with the filmed visits at the child health centre. The children's engagement was defined by the completion and length of the interviews, and the children's interaction with the software. All children gave accounts about their subjective experiences, such as their emotional state during the visit, available toys or rewards they received. All children related to the correct event, they all named at least one person who was present and 87% correctly named at least one examination procedure. The majority of children (91%) completed the interview, which lasted 17-39 min (M = 24), and 96% interacted with the IMS software. IMS was feasible to help children describe their health care experiences, in both detail and depth. The children interacted with the software and maintained their interest for an extended period of time. © 2015 John Wiley & Sons Ltd.

Evaluation of the organisation and effectiveness of internal audits to govern patient safety in hospitals: a mixed-methods study

PubMed Central

van Gelderen, Saskia C; Zegers, Marieke; Boeijen, Wilma; Westert, Gert P; Robben, Paul B; Wollersheim, Hub C

2017-01-01

Objectives Hospital boards are legally responsible for safe healthcare. They need tools to assist them in their task of governing patient safety. Almost every Dutch hospital performs internal audits, but the effectiveness of these audits for hospital governance has never been evaluated. The aim of this study is to evaluate the organisation of internal audits and their effectiveness for hospitals boards to govern patient safety. Design and setting A mixed-methods study consisting of a questionnaire regarding the organisation of internal audits among all Dutch hospitals (n=89) and interviews with stakeholders regarding the audit process and experienced effectiveness of audits within six hospitals. Results Response rate of the questionnaire was 76% and 43 interviews were held. In every responding hospital, the internal audits followed the plan–do–check–act cycle. Every hospital used interviews, document analysis and site visits as input for the internal audit. Boards stated that effective aspects of internal audits were their multidisciplinary scope, their structured and in-depth approach, the usability to monitor improvement activities and to change hospital policy and the fact that results were used in meetings with staff and boards of supervisors. The qualitative methods (interviews and site visits) used in internal audits enable the identification of soft signals such as unsafe culture or communication and collaboration problems. Reported disadvantages were the low frequency of internal audits and the absence of soft signals in the actual audit reports. Conclusion This study shows that internal audits are regarded as effective for patient safety governance, as they help boards to identify patient safety problems, proactively steer patient safety and inform boards of supervisors on the status of patient safety. The description of the Dutch internal audits makes these audits replicable to other healthcare organisations in different settings, enabling hospital boards to complement their systems to govern patient safety. PMID:28698328

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

PubMed

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

2015-12-01

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

Total Quality Management in Logistics: A Case Study from the Trucking Industry

DTIC Science & Technology

1992-06-01

Quality Management (TQM) movement on the logistics industry as a whole, and, more specifically, its impact within the trucking industry. Its focus then narrows to study the practical aspects of implementing a W. Edwards Deming-based quality program within a particular trucking company, Mason Transporters, Inc. The effectiveness of the company’s implementation effort is assessed using data collected from a survey questionnaire, formal interviews, and personal observations during an on- site visit. Successes and shortcomings of the implementation process are highlighted

Planning Self-Managed Work Groups. Features of Self-Managed Work Groups. Results of Using Self-Managed Work Groups. Issues and Implications in Using Self-Managed Work Groups. Status of Ohio Manufacturing Companies.

ERIC Educational Resources Information Center

Smylie, Patrick E.; Jacobs, Ronald L.

A study was conducted to describe the present status of self-managed work groups in Ohio manufacturing companies. Data for the study were gathered through lengthy interviews and site visits with 45 manufacturing companies in the state, 24 employing 2,000-14,000 workers and 21 employing 300 to 1,900 workers. The results of the study are presented…

Interprofessional collaboration in nursing homes (interprof): a grounded theory study of general practitioner experiences and strategies to perform nursing home visits.

PubMed

Fleischmann, Nina; Tetzlaff, Britta; Werle, Jochen; Geister, Christina; Scherer, Martin; Weyerer, Siegfried; Hummers-Pradier, Eva; Mueller, Christiane A

2016-08-30

Interprofessionalism, considered as collaboration between medical professionals, has gained prominence over recent decades and evidence for its impact has grown. The steadily increasing number of residents in nursing homes will challenge medical care and the interaction across professions, especially nurses and general practitioners (GPs). The nursing home visit, a key element of medical care, has been underrepresented in research. This study explores GP perspectives on interprofessional collaboration with a focus on their visits to nursing homes in order to understand their experiences and expectations. This research represents an aspect of the interprof study, which explores medical care needs as well as the perceived collaboration and communication by nursing home residents, their families, GPs and nurses. This paper focusses on GPs' views, investigating in particular their visits to nursing homes in order to understand their experiences. Open guideline-interviews covering interprofessional collaboration and the visit process were conducted with 30 GPs in three study centers and analyzed with grounded theory methodology. GPs were recruited via postal request and existing networks of the research partners. Four different types of nursing home visits were found: visits on demand, periodical visits, nursing home rounds and ad-hoc-decision based visits. We identified the core category "productive performance" of home visits in nursing homes which stands for the balance of GPs´ individual efforts and rewards. GPs used different strategies to perform a productive home visit: preparing strategies, on-site strategies and investing strategies. We compiled a theory of GPs home visits in nursing homes in Germany. The findings will be useful for research, and scientific and management purposes to generate a deeper understanding of GP perspectives and thereby improve interprofessional collaboration to ensure a high quality of care.

What motivates arrangements of dog visits in nursing homes? Experiences by dog handlers and nurses.

PubMed

Gundersen, Ellen Dahl; Johannessen, Berit

2018-05-01

Dog visits to nursing homes are used as a structured approach for enhancing residents' well-being. Few studies have emphasized the perspectives of the organizers. The purpose of the present study was to gain insight into the experiences of volunteer dog handlers and nurses involved in dog visits to nursing homes, focusing on what motivated them to contribute and identifying possible factors to successful dog visits. Individual, in-depth interviews with eight dog handlers and group interviews with 10 nurses from four nursing homes. Feelings of meaningfulness and joy motivated both the dog handlers and nurses to arrange dog visits to nursing homes. Successful visits depended on shared information and collaboration. Both groups were motivated by the positive impact of dog visits on nursing home residents. Dog visits may be health-promoting not only for residents, but for the volunteer dog handlers as well. Copyright © 2018 Elsevier Ltd. All rights reserved.

Post-Interview Communication During Application to Orthopaedic Surgery Residency Programs.

PubMed

Brooks, Jaysson T; Reidler, Jay S; Jain, Amit; LaPorte, Dawn M; Sterling, Robert S

2016-10-05

Post-interview communication from residency programs to applicants is common during the U.S. residency match process. The goals of this study were to understand the frequency and type of post-interview communication, how this communication influences applicants' ranking of programs, whether programs use "second-look" visits to gauge or to encourage applicant interest, and the financial costs to applicants of second-look visits. A post-match survey was sent to 1,198 applicants to one academic orthopaedic residency program over 2 years. The response rates were 15% in 2014 and 31% in 2015, totaling 293 responses used for analysis. Sixty-four percent of applicants reported having post-interview communication with one or more programs. Seventeen percent said that communication caused them to rank the contacting program higher or to keep the program ranked as number 1. Twenty percent felt pressured to reveal their rank position, and 8% were asked to rank a program first in exchange for the program's promise to rank the applicant first. Applicants who received post-interview communication had odds that were 13.5 times higher (95% confidence interval, 6.2 to 30 times higher) of matching to the programs that contacted them. Ninety percent of applicants said that communication from a program did not change how they ranked the program with which they eventually matched. Seventeen percent were encouraged to attend second-look visits, incurring a mean cost of $600 (range, $20 to $8,000). Orthopaedic residency programs continue to communicate with applicants in ways that violate the National Resident Matching Program's Match Communication Code of Conduct, and they continue to encourage second-look visits. To improve the integrity of the match, we suggest that programs use no-reply e-mails to minimize influence and pressure on applicants, interviewers and applicants review the Code of Conduct on interview day and provide instructions on reporting violations to the National Resident Matching Program, all post-interview communication be directed to a standardized or neutral third party, and programs actively discourage second-look visits and stop requiring second-look visits. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

The Resilience of the Health Care Safety Net, 1996–2001

PubMed Central

Felland, Laurie E; Lesser, Cara S; Staiti, Andrea Benoit; Katz, Aaron; Lichiello, Patricia

2003-01-01

Objective To determine how the capacity and viability of local health care safety nets changed over the last six years and to draw lessons from these changes. Data Source The first three rounds (May 1996 to March 2001) of Community Tracking Study site visits to 12 communities. Study Design Researchers visited the study communities every two years to interview leaders of local health care systems about changes in the organization, delivery, and financing of health care and the impact of these changes on people. For this analysis, we collected data on safety net capacity and viability through interviews with public and not-for-profit hospitals, community health centers, health departments, government officials, consumer advocates, academics, and others. We asked about the effects of market and policy changes on the safety net and how the safety net responded, as well as the impact of these changes on care for the low-income uninsured. Principal Findings The safety net in three-quarters of the communities was stable or improved by the end of the study period, leading to improved access to primary and preventive care for the low-income uninsured. Policy responses to pressures such as the Balanced Budget Act and Medicaid managed care, along with effective safety net strategies and supportive conditions, helped reinforce the safety net. However, the safety net in three sites deteriorated and access to specialty services remained inadequate across the 12 sites. Conclusions Despite pessimistic predictions and some notable exceptions, the health care safety net grew stronger over the past six years. Given considerable community variation, however, this analysis indicates that policymakers can apply a number of lessons from strong and improving safety nets to strengthen those that are weaker, particularly as the current economy poses new challenges. PMID:12650377

Acute care patient portals: a qualitative study of stakeholder perspectives on current practices.

PubMed

Collins, Sarah A; Rozenblum, Ronen; Leung, Wai Yin; Morrison, Constance Rc; Stade, Diana L; McNally, Kelly; Bourie, Patricia Q; Massaro, Anthony; Bokser, Seth; Dwyer, Cindy; Greysen, Ryan S; Agarwal, Priyanka; Thornton, Kevin; Dalal, Anuj K

2017-04-01

To describe current practices and stakeholder perspectives of patient portals in the acute care setting. We aimed to: (1) identify key features, (2) recognize challenges, (3) understand current practices for design, configuration, and use, and (4) propose new directions for investigation and innovation. Mixed methods including surveys, interviews, focus groups, and site visits with stakeholders at leading academic medical centers. Thematic analyses to inform development of an explanatory model and recommendations. Site surveys were administered to 5 institutions. Thirty interviews/focus groups were conducted at 4 site visits that included a total of 84 participants. Ten themes regarding content and functionality, engagement and culture, and access and security were identified, from which an explanatory model of current practices was developed. Key features included clinical data, messaging, glossary, patient education, patient personalization and family engagement tools, and tiered displays. Four actionable recommendations were identified by group consensus. Design, development, and implementation of acute care patient portals should consider: (1) providing a single integrated experience across care settings, (2) humanizing the patient-clinician relationship via personalization tools, (3) providing equitable access, and (4) creating a clear organizational mission and strategy to achieve outcomes of interest. Portals should provide a single integrated experience across the inpatient and ambulatory settings. Core functionality includes tools that facilitate communication, personalize the patient, and deliver education to advance safe, coordinated, and dignified patient-centered care. Our findings can be used to inform a "road map" for future work related to acute care patient portals. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Implementation of integrated dual disorders treatment: a qualitative analysis of facilitators and barriers.

PubMed

Brunette, Mary F; Asher, Dianne; Whitley, Rob; Lutz, Wilma J; Wieder, Barbara L; Jones, Amanda M; McHugo, Gregory J

2008-09-01

Approximately half of the people who have serious mental illnesses experience a co-occurring substance use disorder at some point in their lifetime. Integrated dual disorders treatment, a program to treat persons with co-occurring disorders, improves outcomes but is not widely available in public mental health settings. This report describes the extent to which this intervention was implemented by 11 community mental health centers participating in a large study of practice implementation. Facilitators and barriers to implementation are described. Trained implementation monitors conducted regular site visits over two years. During visits, monitors interviewed key informants, conducted ethnographic observations of implementation efforts, and assessed fidelity to the practice model. These data were coded and used as a basis for detailed site reports summarizing implementation processes. The authors reviewed the reports and distilled the three top facilitators and barriers for each site. The most prominent cross-site facilitators and barriers were identified. Two sites reached high fidelity, six sites reached moderate fidelity, and three sites remained at low fidelity over the two years. Prominent facilitators and barriers to implementation with moderate to high fidelity were administrative leadership, consultation and training, supervisor mastery and supervision, chronic staff turnover, and finances. Common facilitators and barriers to implementation of integrated dual disorders treatment emerged across sites. The results confirmed the importance of the use of the consultant-trainer in the model of implementation, as well as the need for intensive activities at multiple levels to facilitate implementation. Further research on service implementation is needed, including but not limited to clarifying strategies to overcome barriers.

Adult emergency department patients with sickle cell pain crisis: results from a quality improvement learning collaborative model to improve analgesic management.

PubMed

Tanabe, Paula; Hafner, John W; Martinovich, Zoran; Artz, Nicole

2012-04-01

The aims of this study were to 1) estimate differences in pain management process and patient-reported outcomes, pre- and postimplementation of analgesic protocols for adults with sickle cell disease (SCD), and 2) examine the effects of site and visit frequency on changes in pain scores and time to analgesic. A multicenter, prospective, longitudinal study enrolled patients from three academic medical centers between October 2007 and September 2009. All ED patients 18 years or older with a chief complaint of a sickle cell pain episode were enrolled. Sites formed a SCD quality improvement (QI) team and implemented standard nurse-initiated emergency department (ED) analgesic protocols; outcomes were compared between study periods defined as pre- and postimplementation of protocols. Medical record review was conducted to measure time to administration of initial analgesic, opioids used, route of opioid administration, the change in pain scores from arrival to discharge (negative numbers reflect a decrease in pain scores), and the number of ED visits per individual patient during the study period at each site. On day 7 after the ED visit, a follow-up phone interview was conducted. Patients were queried about their ED pain management using a scale from 1 to 10 (1 = outstanding, 10 = worst). Descriptive statistics are used to report the results. Ordinary least-squares regression models were constructed to measure the effect of time period, site, and number of visits per patient on change in pain score. During the study period, 342 unique patients (57% female, mean ± SD age = 32 ± 11 years) were enrolled and had a total of 2,934 visits. There was no difference in time to administration of the initial analgesic between study periods. Overall, there was a significant decrease in pain scores from arrival to discharge between the pre- and postintervention study periods: the average difference in arrival to discharge pain scores (cm) was greater during the postimplementation period than during the preintervention period (-4.1 vs. -3.6, t = 2.6, p < 0.01). Site 1 had significant improvement between study periods (mean difference = -0.87, t = 2.63, p < 0.01; F = 14.3, p < 0.01). Patients with few ED visits (one to six annual visits, mean difference = -1.55, t = 2.1, p = 0.04) and those with frequent ED visits (7 to 19 annual visits, mean difference = -1.65, t = 3.52, p < 0.01) had a significant decrease in pain scores compared to patients with very frequent ED visits (>19 visits). There was an overall decrease in the use of morphine sulfate (MS) and increase in the use of hydromorphone (χ(2) = 105.67, p < 0.001) between study periods and a significant increase in the use of oral (PO) and subcutaneous (SC) routes, with a corresponding decrease in the intravenous (IV) route (χ(2) = 13.67, p < 0.001). There were no statistically significant differences in patient-reported satisfaction with the attempt to manage pain in the ED between study periods (p = 0.54). While the use of a learning collaborative and implementation of nurse-initiated analgesic protocols was not associated with improvement in time to administration of the initial analgesic, improvements in the decrease in the arrival to discharge pain score and increased use of hydromorphone and the SC route were noted in adults with SCD in the ED. © 2012 by the Society for Academic Emergency Medicine.

Organizing and managing care in a changing health system.

PubMed

Kohn, L T

2000-04-01

To examine ways in which the management and organization of medical care is changing in response to the shifting incentives created by managed care. Site visits conducted in 12 randomly selected communities in 1996/ 1997. Approximately 35-60 interviews were conducted per site with key informants in healthcare and community organizations; about half were with providers. A standardized interview protocol was implemented across all sites, enabling cross-site comparisons. Multiple respondents were interviewed on each issue. A great deal of experimentation and apparent duplication exist in efforts to develop programs to influence physician practice patterns. Responsibility for managing care is being contested by health plans, medical groups and hospitals, as each seeks to accrue the savings that can result from the more efficient delivery of care. To manage the financial and clinical risk, providers are aggressively consolidating and reorganizing. Most significant was the rapid formation of intermediary organizations, such as independent practice arrangements (IPAs), physician-hospital organizations (PHOs), or management services organizations (MSOs), for contracting with managed care organizations. Managed care appears to have only a modest effect on how healthcare organizations deliver medical care, despite the profound effect that managed care has on how providers are organized. Rather than improving the efficiency of healthcare organizations, provider efforts to build large systems and become indispensable to health plans are exacerbating problems of excess capacity. It is not clear if new organizational arrangements will help providers manage the changing incentives they face, or if their intent is to blunt the effects of the incentives by forming larger organizations to improve their bargaining power and resist change.

Integrating care for high-risk patients in England using the virtual ward model: lessons in the process of care integration from three case sites

PubMed Central

Lewis, Geraint; Vaithianathan, Rhema; Wright, Lorraine; Brice, Mary R; Lovell, Paul; Rankin, Seth; Bardsley, Martin

2013-01-01

Background Patients at high risk of emergency hospitalisation are particularly likely to experience fragmentation in care. The virtual ward model attempts to integrate health and social care by offering multidisciplinary case management to people at high predicted risk of unplanned hospitalisation. Objective To describe the care practice in three virtual ward sites in England and to explore how well each site had achieved meaningful integration. Method Case studies conducted in Croydon, Devon and Wandsworth during 2011–2012, consisting of semi-structured interviews, workshops, and site visits. Results Different versions of the virtual wards intervention had been implemented in each site. In Croydon, multidisciplinary care had reverted back to one-to-one case management. Conclusions To integrate successfully, virtual ward projects should safeguard the multidisciplinary nature of the intervention, ensure the active involvement of General Practitioners, and establish feedback processes to monitor performance such as the number of professions represented at each team meeting. PMID:24250284

Evaluation of the organisation and effectiveness of internal audits to govern patient safety in hospitals: a mixed-methods study.

PubMed

van Gelderen, Saskia C; Zegers, Marieke; Boeijen, Wilma; Westert, Gert P; Robben, Paul B; Wollersheim, Hub C

2017-07-10

Hospital boards are legally responsible for safe healthcare. They need tools to assist them in their task of governing patient safety. Almost every Dutch hospital performs internal audits, but the effectiveness of these audits for hospital governance has never been evaluated. The aim of this study is to evaluate the organisation of internal audits and their effectiveness for hospitals boards to govern patient safety. A mixed-methods study consisting of a questionnaire regarding the organisation of internal audits among all Dutch hospitals (n=89) and interviews with stakeholders regarding the audit process and experienced effectiveness of audits within six hospitals. Response rate of the questionnaire was 76% and 43 interviews were held. In every responding hospital, the internal audits followed the plan-do-check-act cycle. Every hospital used interviews, document analysis and site visits as input for the internal audit. Boards stated that effective aspects of internal audits were their multidisciplinary scope, their structured and in-depth approach, the usability to monitor improvement activities and to change hospital policy and the fact that results were used in meetings with staff and boards of supervisors. The qualitative methods (interviews and site visits) used in internal audits enable the identification of soft signals such as unsafe culture or communication and collaboration problems. Reported disadvantages were the low frequency of internal audits and the absence of soft signals in the actual audit reports. This study shows that internal audits are regarded as effective for patient safety governance, as they help boards to identify patient safety problems, proactively steer patient safety and inform boards of supervisors on the status of patient safety. The description of the Dutch internal audits makes these audits replicable to other healthcare organisations in different settings, enabling hospital boards to complement their systems to govern patient safety. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Creating a Toolkit to Reduce Disparities in Patient Engagement.

PubMed

Keddem, Shimrit; Agha, Aneeza Z; Long, Judith A; Werner, Rachel M; Shea, Judy A

2017-09-01

Patient engagement has become a major focus of health care improvement efforts nationally. Although evidence suggests patient engagement can be beneficial to patients, it has not been consistently defined, operationalized, or translated into practice. Our objective was to develop a toolkit to help providers increase patient engagement and reduce disparities in patient engagement. We used qualitative interviews and observations with staff at primary care sites nationally to identify patient engagement practices and resources used to engage patients. We then used a modified Delphi process, that included a series of conference calls and surveys, where stakeholders reduced lists of engagement practices based on perceived feasibility and importance to develop a toolkit for patient engagement. Sites were selected for interviews and site visits based on the concentration of minority patients served and performance on a measure of patient engagement, with the goal of highlighting practices at sites that successfully serve minority patients. We created a toolkit consisting of patient engagement practices and resources. No identified practice or resource specifically targeted patient engagement of minorities or addressed disparities. However, high-performing, high-minority-serving sites tended to describe more staff training opportunities and staff feedback mechanisms. In addition, low-performing and high-minority-serving sites more often reported barriers to implementation of patient engagement practices. Stakeholders agreed on feasible and important engagement practices. Implementation of this toolkit will be tracked to better understand patient engagement and its effect on patient-centered care and related disparities in care.

Perspectives of family members participating in cultural assessment of psychiatric disorders: Findings from the DSM-5 International Field Trial

PubMed Central

Hinton, Ladson; Aggarwal, Neil; Iosif, Ana-Maria; Weiss, Mitchell; Paralikar, Vasudeo; Deshpande, Smita; Jadhav, Sushrut; Ndetei, David; Nicasio, Andel; Boiler, Marit; Lam, Peter; Avelar, Yesi; Lewis-Fernández, Roberto

2015-01-01

Despite the important roles families play in the lives of many persons with mental illness across cultures, there is a dearth of data worldwide on how family members perceive the process of cultural assessment as well as to how to best include them. This study addresses this gap in our knowledge through analysis of data collected across six countries as part of a DSM-5 Field Trial of the Cultural Formulation Interview (CFI). At clinician discretion, individuals who accompanied patients to the clinic visit (i.e. patient companions) at the time the CFI was conducted were invited to participate in the cultural assessment and answer questions about their experience. The specific aims of this paper are (1) to describe patterns of participation of patient companions in the CFI across the six countries, and (2) to examine the comparative feasibility, acceptability, and clinical utility of the CFI from companion perspectives through analysis of both quantitative and qualitative data. Among the 321 patient interviews, only 86 (at 4 of 12 sites) included companions, all of whom were family members or other relatives. The utility, feasibility and acceptability of the CFI were rated favorably by relatives, supported by qualitative analyses of debriefing interviews. Cross-site differences in frequency of accompaniment merit further study. PMID:25738941

Perspectives of family members participating in cultural assessment of psychiatric disorders: findings from the DSM-5 International Field Trial.

PubMed

Hinton, Ladson; Aggarwal, Neil; Iosif, Ana-Maria; Weiss, Mitchell; Paralikar, Vasudeo; Deshpande, Smita; Jadhav, Sushrut; Ndetei, David; Nicasio, Andel; Boiler, Marit; Lam, Peter; Avelar, Yesi; Lewis-Fernández, Roberto

2015-02-01

Despite the important roles families play in the lives of many individuals with mental illness across cultures, there is a dearth of data worldwide on how family members perceive the process of cultural assessment as well as to how to best include them. This study addresses this gap in our knowledge through analysis of data collected across six countries as part of a DSM-5 Field Trial of the Cultural Formulation Interview (CFI). At clinician discretion, individuals who accompanied patients to the clinic visit (i.e. patient companions) at the time the CFI was conducted were invited to participate in the cultural assessment and answer questions about their experience. The specific aims of this paper are (1) to describe patterns of participation of patient companions in the CFI across the six countries, and (2) to examine the comparative feasibility, acceptability, and clinical utility of the CFI from companion perspectives through analysis of both quantitative and qualitative data. Among the 321 patient interviews, only 86 (at four of 12 sites) included companions, all of whom were family members or other relatives. The utility, feasibility and acceptability of the CFI were rated favourably by relatives, supported by qualitative analyses of debriefing interviews. Cross-site differences in frequency of accompaniment merit further study.

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

ERIC Educational Resources Information Center

Southern Regional Education Board, 2004

2004-01-01

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

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

PubMed

Mohandie, Kris; Meloy, J Reid

2013-05-01

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

Flexible visiting positively impacted on patients, families and staff in an Australian Intensive Care Unit: A before-after mixed method study.

PubMed

Mitchell, Marion L; Aitken, Leanne M

2017-03-01

The admission of a relative to intensive care is stressful for families. To help them support the patient, families need assurance, information and an ability to be near their sick relative. Flexible visiting enables patient access but the impact of this on patients, families and staff is not clear. To assess the impact of flexible visiting from the perspective of patients, families, and Intensive Care Unit (ICU) staff. A before-after mixed method study was used with interviews, focus groups and surveys. Patients were interviewed, family members completed the Family Satisfaction in ICU survey and ICU staff completed a survey and participated in focus groups following the introduction of 21h per day visiting in a tertiary ICU. The study was conducted within a philosophy of family-centred care. All interviewed patients (n=12) positively evaluated the concept of extended visiting hours. Family members' (n=181) overall 'satisfaction with care' did not change; however 85% were 'very satisfied' with increased visiting flexibility. Seventy-six percent of family visits continued to occur within the previous visiting hours (11am-8pm) with the remaining 24% taking place during the newly available visiting hours. Families recognised the priority of patient care with their personal needs being secondary. Three-quarters of ICU staff were 'satisfied' with flexible visiting and suggested any barriers could be overcome by role modelling family inclusion. Patients, families and ICU staff positively evaluated flexible visiting hours in this ICU. Although only a minority of families took advantage of the increased hours they indicated appreciation for the additional opportunities. Junior staff may benefit from peer-support to develop family inclusion skills. More flexible visiting times can be incorporated into usual ICU practice in a manner that is viewed positively by all stakeholders. Copyright © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Collaborating across the Departments of Veterans Affairs and Defense to integrate mental health and chaplaincy services.

PubMed

Nieuwsma, Jason A; Jackson, George L; DeKraai, Mark B; Bulling, Denise J; Cantrell, William C; Rhodes, Jeffrey E; Bates, Mark J; Ethridge, Keith; Lane, Marian E; Tenhula, Wendy N; Batten, Sonja V; Meador, Keith G

2014-12-01

Recognizing that clergy and spiritual care providers are a key part of mental health care systems, the Department of Veterans Affairs (VA) and Department of Defense (DoD) jointly examined chaplains' current and potential roles in caring for veterans and service members with mental health needs. Our aim was to evaluate the intersection of chaplain and mental health care practices in VA and DoD in order to determine if improvement is needed, and if so, to develop actionable recommendations as indicated by evaluation findings. A 38-member multidisciplinary task group partnered with researchers in designing, implementing, and interpreting a mixed methods study that included: 1) a quantitative survey of VA and DoD chaplains; and 2) qualitative interviews with mental health providers and chaplains. Quantitative: the survey included all full-time VA chaplains and all active duty military chaplains (n = 2,163 completed of 3,464 invited; 62 % response rate). Qualitative: a total of 291 interviews were conducted with mental health providers and chaplains during site visits to 33 VA and DoD facilities. Quantitative: the online survey assessed intersections between chaplaincy and mental health care and took an average of 37 min to complete. Qualitative: the interviews assessed current integration of mental health and chaplain services and took an average of 1 h to complete. When included on interdisciplinary mental health care teams, chaplains feel understood and valued (82.8-100 % of chaplains indicated this, depending on the team). However, findings from the survey and site visits suggest that integration of services is often lacking and can be improved. Closely coordinating with a multidisciplinary task group in conducting a mixed method evaluation of chaplain-mental health integration in VA and DoD helped to ensure that researchers assessed relevant domains and that findings could be rapidly translated into actionable recommendations.

Human outbreak of Salmonella Typhimurium associated with exposure to locally made chicken jerky pet treats, New Hampshire, 2013.

PubMed

Cavallo, Steffany J; Daly, Elizabeth R; Seiferth, John; Nadeau, Alisha M; Mahoney, Jennifer; Finnigan, Jayne; Wikoff, Peter; Kiebler, Craig A; Simmons, Latoya

2015-05-01

Pet treats and pet food can be contaminated with Salmonella and other pathogens, though they are infrequently implicated as the source of human outbreaks. In 2013, the New Hampshire Department of Health and Human Services investigated a cluster of Salmonella Typhimurium infections associated with contaminated locally made pet treats. Case-patients were interviewed with standardized questionnaires to assess food, animal, and social histories. Laboratory and environmental investigations were conducted, including testing of clinical specimens, implicated product, and environmental swabs. Between June and October 2013, a total of 43 ill persons were identified. Sixteen patients (37%) were hospitalized. Among 43 case-patients interviewed, the proportion exposed to dogs (95%) and pet treats (69%) in the 7 days prior to illness was statistically higher than among participants in a U.S. population-based telephone survey (61%, p<0.0001 and 16%, p<0.0001, respectively). On further interview, 38 (88%) reported exposure to Brand X Chicken Jerky, the maker of Brand X chicken jerky, or the facility in which it was made. Product testing isolated the outbreak strain from four of four Brand X Chicken Jerky samples, including an unopened package purchased at retail, opened packages collected from patient households, and unpackaged jerky obtained from the jerky maker. A site visit revealed inadequate processing of the chicken jerky, bare-hand contact with the finished product prior to packaging, and use of vacuum-sealed packaging, which may have enabled facultative anaerobic bacteria to proliferate. Seven (78%) of nine environmental swabs taken during the site visit also yielded the outbreak strain. Brand X Chicken Jerky was voluntarily recalled on September 9, 2013. Consumers should be made aware of the potential for locally made products to be exempt from regulation and for animals and animal food to carry pathogens that cause human illness, and be educated to perform hand hygiene after handling pet food or treats.

Patient Perceptions of Telehealth Primary Care Video Visits.

PubMed

Powell, Rhea E; Henstenburg, Jeffrey M; Cooper, Grace; Hollander, Judd E; Rising, Kristin L

2017-05-01

Telehealth is a care delivery model that promises to increase the flexibility and reach of health services. Our objective is to describe patient experiences with video visits performed with their established primary care clinicians. We constructed semistructured, in-depth qualitative interviews with adult patients following video visits with their primary care clinicians at a single academic medical center. Data were analyzed with a content analysis approach. Of 32 eligible patients, 19 were successfully interviewed. All patients reported overall satisfaction with video visits, with the majority interested in continuing to use video visits as an alternative to in-person visits. The primary benefits cited were convenience and decreased costs. Some patients felt more comfortable with video visits than office visits and expressed a preference for receiving future serious news via video visit, because they could be in their own supportive environment. Primary concerns with video visits were privacy, including the potential for work colleagues to overhear conversations, and questions about the ability of the clinician to perform an adequate physical examination. Primary care video visits are acceptable in a variety of situations. Patients identified convenience, efficiency, communication, privacy, and comfort as domains that are potentially important to consider when assessing video visits vs in-person encounters. Future studies should explore which patients and conditions are best suited for video visits. © 2017 Annals of Family Medicine, Inc.

Telephone audit for monitoring stroke unit facilities: a post hoc analysis from PROSIT study.

PubMed

Candelise, Livia; Gattinoni, Monica; Bersano, Anna

2015-01-01

Although several valid approaches exist to measure the number and the quality of acute stroke units, only few studies tested their reliability. This study is aimed at establishing whether the telephone administration of the PROject of Stroke unIt ITaly (PROSIT) audit questionnaire is reliable compared with direct face-to-face interview. Forty-three medical leaders in charge of in-hospital stroke services were interviewed twice using the same PROSIT questionnaire with 2 different modalities. First, the interviewers approached the medical leaders by telephone. Thereafter, they went to the hospital site and performed a direct face-to-face interview. Six independent couples of trained researchers conducted the audit interviews. The degree of intermodality agreement was measured with kappa statistic. We found a perfect agreement for stroke units identification between the 2 different audit modalities (K = 1.00; standard error [SE], 1.525). The agreement was also very good for stroke dedicated beds (K = 1.00; SE, 1.525) and dedicated personnel (K = 1.00; SE, 1.525), which are the 2 components of stroke unit definition. The agreement was lower for declared in use process of care and availability of diagnostic investigations. The telephone audit can be used for monitoring stroke unit structures. It is more rapid, less expensive, and can repeatedly be used at appropriate intervals. However, a reliable description of the process of care and diagnostic investigations indicators should be obtained by either local site audit visit or prospective stroke register based on individual patient data. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Understanding elementary teacher motivations for science fieldtrips

NASA Astrophysics Data System (ADS)

Kisiel, James

2005-11-01

This investigation sought to identify the motivations that comprise teachers' agendas when leading student fieldtrips to science museums or similar sites. A survey distributed to upper elementary teachers resulted in a variety of open-ended responses that were analyzed and coded to identify recurring themes. In addition, ten teachers planning to lead a school trip to a natural history museum were interviewed and observed. Interview and observation data were used to triangulate findings and refine descriptions of actual practice. Eight fieldtrip motivations were identified including to connect with the classroom curriculum, to provide a general learning experience, to encourage lifelong learning, to enhance interest and motivation, to provide exposure to new experiences, to provide a change in setting or routine, for enjoyment, and to meet school expectations. Results indicated that connecting to the classroom curriculum was an important consideration, although teachers had different interpretations of what this meant. Further examination of the teachers' agendas suggested the influence of different contexts, including that of the school and the museum site. These findings lead to suggestions for facilitating school visits to informal settings by considering the teachers' fieldtrip perspectives and agendas.

Emergency Department Visits for Nontraumatic Dental Problems: A Mixed-Methods Study

PubMed Central

Chi, Donald L.; Schwarz, Eli; Milgrom, Peter; Yagapen, Annick; Malveau, Susan; Chen, Zunqui; Chan, Ben; Danner, Sankirtana; Owen, Erin; Morton, Vickie; Lowe, Robert A.

2015-01-01

Objectives. We documented emergency department (ED) visits for nontraumatic dental problems and identified strategies to reduce ED dental visits. Methods. We used mixed methods to analyze claims in 2010 from a purposive sample of 25 Oregon hospitals and Oregon’s All Payer All Claims data set and interviewed 51 ED dental visitors and stakeholders from 6 communities. Results. Dental visits accounted for 2.5% of ED visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years, were associated with being uninsured (odds ratio [OR] = 5.2 [reference: commercial insurance]; 95% confidence interval [CI] = 4.8, 5.5) or having Medicaid insurance (OR = 4.0; 95% CI = 3.7, 4.2), resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated $402 (95% CI = $396, $408) in hospital costs per visit. Interviews revealed health system, community, provider, and patient contributors to ED dental visits. Potential solutions provided by interviewees included Medicaid benefit expansion, care coordination, water fluoridation, and patient education. Conclusions. Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits. PMID:25790415

Prescribed Fire: The Influence of Site Visits on Citizen Attitudes

ERIC Educational Resources Information Center

Toman, Eric; Shindler, Bruce; Reed, Michelle

2004-01-01

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

Federal Update: College Groups Ask Secretary of State To Postpone New Interview Requirements for Visa Applicants.

ERIC Educational Resources Information Center

Milshtein, Amy

2003-01-01

Foreign students and visiting scholars are facing delays as, in the wake of the September 11th attacks, new requirements for visa interviews for every applicant are slowing down the process. Many students and visiting scholars are at risk of missing the start of the school year. Some school groups are petitioning the U.S. State Department for…

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

NASA Astrophysics Data System (ADS)

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

2016-12-01

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

A simple way to increase service use: triggers of women’s uptake of postpartum services

PubMed Central

Kabakian-Khasholian, Tamar; Campbell, Oona M.R.

2006-01-01

Objective To examine the socio-demographic and service-related determinants of utilisation of postpartum services. Design Data were used from a single-blind, randomised controlled trial aimed at changing women’s knowledge, attitude and behaviour regarding certain postpartum health issues by providing written information via a specially prepared booklet. Setting Four private hospitals, two in Beirut and two in the Bekaa region, were selected. All were privately owned and one in Beirut was a teaching hospital. Sample All women delivering a live birth in the designated hospitals during a three- to four-month period were recruited into the study. Of the 503 eligible women, 450 agreed to complete the initial questionnaire and 378 completed the postpartum interviews. Methods Eight trained female interviewers collected the baseline data. On discharge, interviewers handed each woman a sealed and numbered envelope containing the intervention booklet or the placebo leaflets. Interviewers were blind about the allocation group of women. Interviewers conducted follow up assessment at women’s residence 6–20 weeks after delivery. Main outcome measures Any postpartum visit with or without a preset appointment. Results Multivariable analysis with adjusted ORs show that women given an appointment for their postpartum visit were more likely to having had that visit (OR = 6.8, 95% CI 6.2–7.4). In the absence of such an appointment, university education (OR = 3.6, 95% CI 2.6–4.7), information on maternal health (OR = 4.9, 95% CI 4.0–5.8) and the intervention booklet (OR = 2.9, 95% CI 2.0–3.9) were important determinants of a postpartum visit. Conclusion Giving women appointments for postpartum visits, or written or verbal information on maternal health can increase their use of health services. PMID:16101614

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

Treesearch

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

2011-01-01

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

Three models of community mental health services In low-income countries

PubMed Central

2011-01-01

Objective To compare and contrast three models of community mental health services in low-income settings. Data Sources/Study Setting Primary and secondary data collected before, during, and after site visits to mental health programs in Nigeria, the Philippines, and India. Study Design Qualitative case study methodology. Data Collection Data were collected through interviews and observations during site visits to the programs, as well as from reviews of documentary evidence. Principal Findings A set of narrative topics and program indicators were used to compare and contrast three community mental health programs in low-income countries. This allowed us to identify a diversity of service delivery models, common challenges, and the strengths and weaknesses of each program. More definitive evaluations will require the establishment of data collection methods and information systems that provide data about the clinical and social outcomes of clients, as well as their use of services. Conclusions Community mental health programs in low-income countries face a number of challenges. Using a case study methodology developed for this purpose, it is possible to compare programs and begin to assess the effectiveness of diverse service delivery models. PMID:21266051

Medication safety infrastructure in critical-access hospitals in Florida.

PubMed

Winterstein, Almut G; Hartzema, Abraham G; Johns, Thomas E; De Leon, Jessica M; McDonald, Kathie; Henshaw, Zak; Pannell, Robert

2006-03-01

The medication safety infrastructure of critical-access hospitals (CAHs) in Florida was evaluated. Qualitative assessments, including a self-administered survey and site visits, were conducted in seven of nine CAHs between January and June 2003. The survey consisted of the Institute for Safe Medication Practices Medication Safety Self-assessment, the 2003 Joint Commission on Accreditation of Healthcare Organizations patient safety goals, health information technology (HIT) questions, and medication-use-process flow charts. On-site visits included interviews of CAH personnel who had safety responsibility and inspections of pharmacy facilities. The findings were compiled into a matrix reflecting structural and procedural components of the CAH medication safety infrastructure. The nine characteristics that emerged as targets for quality improvement (QI) were medication accessibility and storage, sterile product compounding, access to drug information, access to and utilization of patient information in medication order review, advanced safety technology, drug formularies and standardized medication protocols, safety culture, and medication reconciliation. Based on weighted importance and feasibility, QI efforts in CAHs should focus on enhancing medication order review systems, standardizing procedures for handling high-risk medications, promoting an appropriate safety culture, involvement in seamless care, and investment in HIT.

Biological and Behavioral Risks for Incident Chlamydia trachomatis Infection in a Prospective Cohort

PubMed Central

Hwang, Loris Y.; Ma, Yifei; Moscicki, Anna-Barbara

2014-01-01

Objective To identify biological and behavioral risks for incident Chlamydia trachomatis among a prospective cohort of young women followed frequently. Methods Our cohort of 629 women from two outpatient sites was seen every 4 months (October 2000 through April 2012) for behavioral interviews and infection testing. C trachomatis was tested annually, and anytime patients reported symptoms or possible exposure using commercial nucleic acid amplification tests. Analyses excluded baseline prevalent C trachomatis infections. Risk factors for incident C trachomatis were assessed using Cox proportional hazards models. Significant risks (p<0.10) from bivariate models were entered in a multivariate model, adjusted for four covariates chosen a priori (age, race or ethnicity, condom use, study site). Backwards step-wise elimination produced a final parsimonious model retaining significant variables (p<0.05) and the four adjustment variables. Results The 629 women attended 9,594 total visits. Median follow-up time was 6.9 years (interquartile range 3.2-9.8), during which 97 (15%) women had incident C trachomatis . In the final multivariate model, incident C trachomatis was independently associated with HPV at the preceding visit (p<0.01), smoking (p=0.02), and weekly use of substances besides alcohol and marijuana (p<0.01) since prior visit. Among 207 women with available colpophotographs (1,742 visits), cervical ectopy was not a significant risk factor (p range=0.16-0.39 for ectopy as continuous and ordinal variables). Conclusion Novel risks for C trachomatis include preceding HPV, smoking, and substance use, which may reflect both biological and behavioral mechanisms of risk, such as immune modulation, higher-risk sexual networks, or both. Improved understanding of the biological bases for C trachomatis risk would inform our strategies for C trachomatis control. PMID:25437724

Establishing a health information workforce: innovation for low- and middle-income countries.

PubMed

Ledikwe, Jenny H; Reason, Letitia L; Burnett, Sarah M; Busang, Lesego; Bodika, Stephane; Lebelonyane, Refeletswe; Ludick, Steven; Matshediso, Ellah; Mawandia, Shreshth; Mmelesi, Mpho; Sento, Baraedi; Semo, Bazghina-Werq

2013-07-18

To address the shortage of health information personnel within Botswana, an innovative human resources approach was taken. University graduates without training or experience in health information or health sciences were hired and provided with on-the-job training and mentoring to create a new cadre of health worker: the district Monitoring and Evaluation (M&E) Officer. This article describes the early outcomes, achievements, and challenges from this initiative. Data were collected from the district M&E Officers over a 2-year period and included a skills assessment at baseline and 12 months, pre- and post-training tests, interviews during stakeholder site visits, a survey of achievements, focus group discussions, and an attrition assessment. An average of 2.7 mentoring visits were conducted for M&E Officers in each district. There were five training sessions over 18 months. Knowledge scores significantly increased (p < 0.05) during the three trainings in which pre/post tests were administered. Over 1 year, there were significant improvements (p < 0.05) in self-rated skills related to computer literacy, checking data validity, implementing data quality procedures, using data to support program planning, proposing indicators, and writing M&E reports. Out of the 34 district M&E Officers interviewed during site visits, most were conducting facility visits to review data (27/34; 79%), comparing data sets over time (31/34; 91%), backing up data (32/34; 94%), and analyzing data (32/34; 94%). Common challenges included late facility reports (28/34; 82%), lack of transportation (22/34; 65%), inaccurate facility reports (10/34; 29%), and colleagues' misunderstanding of M&E (10/34; 29%). Six posts were vacated in the first year (6/51; 12%). A total of 49 Officers completed the achievements survey; of these, common accomplishments related to improvements in data management (35/49; 71%), data quality (31/49; 63%), data use (29/49; 59%), and capacity development (26/49; 53%). The development of a cadre of district M&E Officers has contributed positively to the health information system in Botswana. In the absence of tertiary training related to health information, on-the-job training and mentoring of university graduates can be an effective approach for developing a new professional cadre of M&E expertise and for strengthening capacity within a national health system.

Establishing a health information workforce: innovation for low- and middle-income countries

PubMed Central

2013-01-01

Background To address the shortage of health information personnel within Botswana, an innovative human resources approach was taken. University graduates without training or experience in health information or health sciences were hired and provided with on-the-job training and mentoring to create a new cadre of health worker: the district Monitoring and Evaluation (M&E) Officer. This article describes the early outcomes, achievements, and challenges from this initiative. Methods Data were collected from the district M&E Officers over a 2-year period and included a skills assessment at baseline and 12 months, pre- and post-training tests, interviews during stakeholder site visits, a survey of achievements, focus group discussions, and an attrition assessment. Results An average of 2.7 mentoring visits were conducted for M&E Officers in each district. There were five training sessions over 18 months. Knowledge scores significantly increased (p < 0.05) during the three trainings in which pre/post tests were administered. Over 1 year, there were significant improvements (p < 0.05) in self-rated skills related to computer literacy, checking data validity, implementing data quality procedures, using data to support program planning, proposing indicators, and writing M&E reports. Out of the 34 district M&E Officers interviewed during site visits, most were conducting facility visits to review data (27/34; 79%), comparing data sets over time (31/34; 91%), backing up data (32/34; 94%), and analyzing data (32/34; 94%). Common challenges included late facility reports (28/34; 82%), lack of transportation (22/34; 65%), inaccurate facility reports (10/34; 29%), and colleagues’ misunderstanding of M&E (10/34; 29%). Six posts were vacated in the first year (6/51; 12%). A total of 49 Officers completed the achievements survey; of these, common accomplishments related to improvements in data management (35/49; 71%), data quality (31/49; 63%), data use (29/49; 59%), and capacity development (26/49; 53%). Conclusions The development of a cadre of district M&E Officers has contributed positively to the health information system in Botswana. In the absence of tertiary training related to health information, on-the-job training and mentoring of university graduates can be an effective approach for developing a new professional cadre of M&E expertise and for strengthening capacity within a national health system. PMID:23866794

Tales from the New Frontier: Pioneers' Experiences with Consumer-Driven Health Care

PubMed Central

Lo Sasso, Anthony T; Rice, Thomas; Gabel, Jon R; Whitmore, Heidi

2004-01-01

Objective To conduct site visits to study the early experiences of firms offering consumer-driven health care (CDHC) plans to their employees and firms that provide CDHC products. Data Sources/Study Setting A convenience sample of three firms offering CDHC products to their employees, one of which is also a large insurer, and one firm offering an early CDHC product to employers. Study Design We conducted onsite interviews of four companies during the spring and summer of 2003. These four cases were not selected randomly. We contacted organizations that already had a consumer-driven plan in place by January 2002 so as to provide a complete year's worth of experience with CDHC. Principal Findings The experience of the companies we visited indicated that favorable selection tends to result when a CDHC plan is introduced alongside traditional preferred provider organization (PPO) and health maintenance organization (HMO) plan offerings. Two sites demonstrated substantial cost-savings. Our case studies also indicate that the more mundane aspects of health care benefits are still crucial under CDHC. The size of the provider network accessible through the CDHC plan was critical, as was the role of premium contributions in the benefit design. Also, companies highlighted the importance of educating employees about new CDHC products: employees who understood the product were more likely to enroll. Conclusions Our site visits suggest the peril (risk selection) and the promise (cost savings) of CDHC. At this point there is still far more that we do not know about CDHC than we do know. Little is known about the extent to which CDHC changes people's behavior, the extent to which quality of care is affected by CDHC, and whether web-based information and tools actually make patients become better consumers. PMID:15230912

Tales from the new frontier: pioneers' experiences with consumer-driven health care.

PubMed

Lo Sasso, Anthony T; Rice, Thomas; Gabel, Jon R; Whitmore, Heidi

2004-08-01

To conduct site visits to study the early experiences of firms offering consumer-driven health care (CDHC) plans to their employees and firms that provide CDHC products. A convenience sample of three firms offering CDHC products to their employees, one of which is also a large insurer, and one firm offering an early CDHC product to employers. We conducted onsite interviews of four companies during the spring and summer of 2003. These four cases were not selected randomly. We contacted organizations that already had a consumer-driven plan in place by January 2002 so as to provide a complete year's worth of experience with CDHC. The experience of the companies we visited indicated that favorable selection tends to result when a CDHC plan is introduced alongside traditional preferred provider organization (PPO) and health maintenance organization (HMO) plan offerings. Two sites demonstrated substantial cost-savings. Our case studies also indicate that the more mundane aspects of health care benefits are still crucial under CDHC. The size of the provider network accessible through the CDHC plan was critical, as was the role of premium contributions in the benefit design. Also, companies highlighted the importance of educating employees about new CDHC products: employees who understood the product were more likely to enroll. Our site visits suggest the peril (risk selection) and the promise (cost savings) of CDHC. At this point there is still far more that we do not know about CDHC than we do know. Little is known about the extent to which CDHC changes people's behavior, the extent to which quality of care is affected by CDHC, and whether web-based information and tools actually make patients become better consumers.

Randomised controlled trial of alternative male and female condom promotion strategies targeting sex workers in Madagascar.

PubMed

Hoke, Theresa H; Feldblum, Paul J; Damme, Kathleen Van; Nasution, Marlina D; Grey, Thomas W; Wong, Emelita L; Ralimamonjy, Louisette; Raharimalala, Leonardine; Rasamindrakotroka, Andry

2007-10-01

To assess whether individual clinic-based counselling as a supplement to peer education for male and female condom promotion leads to greater use of protection and lower STI prevalence among sex workers in Madagascar already exposed to intensive male condom promotion. In two public dispensaries in Madagascar, a total of 901 sex workers were randomly allocated between two alternative male and female condom promotion peer education only, or peer education supplemented with individual clinic-based counselling. Participants were followed for 12 months. Every 2 months they made clinic visits, where they were interviewed on condom use. Peer educators counselled all participants on condom use as they accompanied their assigned participants to study visits. Participants assigned to receive the supplemental intervention were counselled by a trained clinician following study interviews. Participants were tested and treated for chlamydia, gonorrhoea and trichomoniasis every 6 months. We used logistic regression to assess whether the more intensive intervention was associated with reduced STI prevalence. Use of protection with clients and non-paying partners was assessed by study arm, site, and visit. There was no statistically significant association between study arm and aggregated STI prevalence. No substantial differences in levels of reported protection were noted between study groups. This study found little evidence for gains from more thorough clinical counselling on male and female condom use. These findings suggest that less clinically intensive interventions such as peer education could be suitable for male and female condom promotion in populations already exposed to barrier method promotion.

Aviation human factors research in U.S. universities: Potential contributions to national needs

NASA Technical Reports Server (NTRS)

Key Dismukes, R.

1994-01-01

Univesity research can make vital contributions to national needs in aviation human factors (AHF). This article examines the types of expertise and facilities available in universities and explores how university capabilities complement the work of government laboratories. The AHF infrastructure is discussed and compared to other fields of applied research. Policy and funding issues are also examined. This study is based on a survey conducted by the author, which included site visits to several universities, telephone interviews with faculty members at other universities, and a search of the AHF research literature.

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

PubMed

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

2016-10-06

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

Evaluating the impact of patients' online access to doctors' visit notes: designing and executing the OpenNotes project

PubMed Central

2012-01-01

Background Providers and policymakers are pursuing strategies to increase patient engagement in health care. Increasingly, online sections of medical records are viewable by patients though seldom are clinicians' visit notes included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We hypothesized that patients and primary care physicians (PCPs) would want it to continue and that OpenNotes would not lead to significant disruptions to doctors' practices. Methods/Design Using a mixed methods approach, we designed a quasi-experimental study in 3 diverse healthcare systems in Boston, Pennsylvania, and Seattle. Two sites had existing patient internet portals; the third used an experimental portal. We targeted 3 key areas where we hypothesized the greatest impacts: beliefs and attitudes about OpenNotes, use of the patient internet portals, and patient-doctor communication. PCPs in the 3 sites were invited to participate in the intervention. Patients who were registered portal users of participating PCPs were given access to their PCPs' visit notes for one year. PCPs who declined participation in the intervention and their patients served as the comparison groups for the study. We applied the RE-AIM framework to our design in order to capture as comprehensive a picture as possible of the impact of OpenNotes. We developed pre- and post-intervention surveys for online administration addressing attitudes and experiences based on interviews and focus groups with patients and doctors. In addition, we tracked use of the internet portals before and during the intervention. Results PCP participation varied from 19% to 87% across the 3 sites; a total of 114 PCPs enrolled in the intervention with their 22,000 patients who were registered portal users. Approximately 40% of intervention and non-intervention patients at the 3 sites responded to the online survey, yielding a total of approximately 38,000 patient surveys. Discussion Many primary care physicians were willing to participate in this "real world" experiment testing the impact of OpenNotes on their patients and their practices. Results from this trial will inform providers, policy makers, and patients who contemplate such changes at a time of exploding interest in transparency, patient safety, and improving the quality of care. PMID:22500560

Visiting the cinema, concerts, museums or art exhibitions as determinant of survival: a Swedish fourteen-year cohort follow-up.

PubMed

Konlaan, B B; Bygren, L O; Johansson, S E

2000-09-01

The aim of this study was to ascertain the possible influence of attending various kinds of cultural events or visiting cultural institutions as a determinant of survival. A cohort of individuals aged 25-74 years from a random sample were interviewed by trained non-medical interviewers in 1982 and 1983. The interviews covered standard-of-living variables. Our independent variables covered visiting cultural institutions and attendance at cultural events, reading books or periodicals, and music making. The non-response rate was about 25%. The cohort was followed with respect to survival for 14 years up to 31st December 1996. The background covariates that were used for control purposes were age, sex, cash buffer, educational standard, long-term disease, smoking, and physical exercise. Our setting was the Swedish survey of living conditions among the adult Swedish population aged 25-74 years. About 10,609 individuals were interviewed in 1982 and 1983. The outcome measure was survival until 31st December 1996. In all, 916 men and 600 women died during this period. We found a higher mortality risk for those people who rarely visited the cinema, concerts, museums, or art exhibitions compared with those visiting them most often. The significant relative risks ranging between RR 1.14 (95% CI. 1.01-1.31) of attending art exhibitions, and RR 1.42 (CI. 1.25-1.60) of attending museums, when adjusting for the nine other variables. Visits to the cinema and concerts gave significant RR in between. We could not discern any beneficial effect of attending the theatre, church service or sports event as a spectator or any effect of reading or music making. Our conclusion is that attendance at certain kinds of cultural events may have a beneficial effect on longevity.

The Outcomes of Chinese Visiting Scholars' Experiences at Canadian Universities: Implications for Faculty Development at Chinese Universities

ERIC Educational Resources Information Center

Liu, Qin; Jiang, Yumei

2015-01-01

This article examines the outcomes of the overseas experiences of Chinese visiting scholars and the implications of visiting scholar programs for faculty development at Chinese universities. On the basis of semi-structured interviews with 17 returned Chinese visiting scholars who spent six to 12 months in a faculty of education at one of five…

Adding Value to the Health Care System: Identifying Value-Added Systems Roles for Medical Students.

PubMed

Gonzalo, Jed D; Graaf, Deanna; Johannes, Bobbie; Blatt, Barbara; Wolpaw, Daniel R

To catalyze learning in Health Systems Science and add value to health systems, education programs are seeking to incorporate students into systems roles, which are not well described. The authors sought to identify authentic roles for students within a range of clinical sites and explore site leaders' perceptions of the value of students performing these roles. From 2013 to 2015, site visits and interviews with leadership from an array of clinical sites (n = 30) were conducted. Thematic analysis was used to identify tasks and benefits of integrating students into interprofessional care teams. Types of systems roles included direct patient benefit activities, including monitoring patient progress with care plans and facilitating access to resources, and clinic benefit activities, including facilitating coordination and improving clinical processes. Perceived benefits included improved value of the clinical mission and enhanced student education. These results elucidate a framework for student roles that enhance learning and add value to health systems.

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

ERIC Educational Resources Information Center

1996

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

Motivational interviewing in inflammatory bowel disease patients: a useful tool for outpatient counselling.

PubMed

Mocciaro, Filippo; Di Mitri, Roberto; Russo, Giuseppina; Leone, Salvo; Quercia, Valerio

2014-10-01

Most inflammatory bowel disease patients miss follow-up visits and are non-adherent to therapy due to the lack of an engaging patient-physician relationship. Motivational interviewing is a patient-centred counselling method used to elicit/strengthen motivation towards change. The aim of this study was to assess the role of motivational interviewing in patients affected by inflammatory bowel disease. The study included consecutive patients with inflammatory bowel disease presenting for the first consultation (June 2012-February 2013). All consultations were carried out applying the motivational interviewing approach. After each consultation, patients filled out a questionnaire asking demographic data, and their past and current experience. Overall, 23 males (51.1%) and 22 females (48.9%), mean age 36.1±15.2 years, were enrolled. Before and after experiencing the motivational interviewing approach (mean visit duration 41.5±8.7min) "overall satisfaction rate", "physician's communication skills", and "perceived empathy" were 60% vs 100%, 40% vs 95.6%, and 40% vs 100%, respectively. Satisfaction was lower in patients affected by indeterminate colitis (p=0.004), and of younger age (p=0.02). The motivational interview approach is appreciated by inflammatory bowel disease patients. Despite being time-consuming, the motivational interview appears considerably worthwhile at the first visit and in younger patients. Motivational interviewing can help physicians to deal with their patients, moving from "cure" to "care". Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Burden of Self-reported Acute Gastrointestinal Illness in Cuba

PubMed Central

Prieto, Pablo Aguiar; Finley, Rita L.; Guerin, Michele T.; Isaacs, Sandy; Domínguez, Arnaldo Castro; Marie, Gisele Coutín; Perez, Enrique

2009-01-01

Acute gastrointestinal illness is an important public-health issue worldwide. Burden-of-illness studies have not previously been conducted in Cuba. The objective of the study was to determine the magnitude, distribution, and burden of self-reported acute gastrointestinal illness in Cuba. A retrospective, cross-sectional survey was conducted in three sentinel sites during June-July 2005 (rainy season) and during November 2005–January 2006 (dry season). Households were randomly selected from a list maintained by the medical offices in each site. One individual per household was selected to complete a questionnaire in a face-to-face interview. The case definition was three or more bouts of loose stools in a 24-hour period within the last 30 days. In total, 97.3% of 6,576 interviews were completed. The overall prevalence of acute gastrointestinal illness was 10.6%. The risk of acute gastrointestinal illness was higher during the rainy season (odds ratio [OR]=3.85, 95% confidence interval [CI] 3.18-4.66) in children (OR=3.12, 95% CI 2.24-4.36) and teens (OR=2.27, 95% CI 1.51-3.41) compared to people aged 25-54 years, in males (OR=1.24, 95% CI 1.04-1.47), and in the municipality of Santiago de Cuba (OR=1.33, 95% CI 1.11-1.61). Of 680 cases, 17.1-38.1% visited a physician, depending on sentinel site. Of the cases who visited a physician, 33.3-53.9% were requested to submit a stool sample, and of those, 72.7-100.0% complied. Of the cases who sought medical care, 16.7- 61.5% and 0-31.6% were treated with antidiarrhoeals and antibiotics respectively. Acute gastrointestinal illness represented a substantial burden of health compared to developed countries. Targeting the identified risk factors when allocating resources for education, food safety, and infrastructure might lower the morbidity associated with acute gastrointestinal illness. PMID:19507750

ICU visiting policies.

PubMed

Youngner, S J; Coulton, C; Welton, R; Juknialis, B; Jackson, D L

1984-07-01

Head nurses from 78 ICUs in 37 northeast Ohio hospitals were interviewed about visiting policies. There was tremendous variation with regard to frequency and length of visits; 25% of these ICUs allowed only 2 visits/day, and 42% restricted visits to under 20 min. Most units rarely or never allowed children under 12 yr old to visit. Traditional rationales for restricted visiting are not supported by studies in the literature, nor are they consistent with current concepts of patients' rights. In an era where high technology and medicine by-the-numbers threaten to dehumanize patients, open visiting is an important part of the humanization process.

19 CFR 10.553 - Textile and apparel site visits.

Code of Federal Regulations, 2010 CFR

2010-04-01

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

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

PubMed Central

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

2014-01-01

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

Daytime School Guided Visits to an Astronomical Observatory in Brazil

ERIC Educational Resources Information Center

Colombo, Pedro Donizete, Jr.; Silva, Cibelle Celestino; Aroca, Silvia Calbo

2010-01-01

This article analyzes the activity "Daytime School Guided Visits" at an astronomical observatory in Brazil with pupils from primary school. The adopted research methodology relied on questionnaire applications and semistructured interviews. The objectives were to identify the influences of the visits on learning of astronomical concepts…

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

PubMed

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

2017-07-01

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

Exploring patients' reasons for participation in a medical education home visit program: a qualitative study in Malaysia.

PubMed

Tan, Chai-Eng; Jaffar, Aida; Tohit, Noorlaili; Hamzah, Zuhra; Hashim, Syahnaz Mohd

2017-06-01

Direct contact with patients for medical education is essential in healthcare professional training. Patients who were recruited for a medical education home visit program in Malaysia did so on a voluntary basis without remuneration. This paper aims to explore their reasons for participation in this program. An exploratory qualitative study was conducted on patients who had been visited during the 2012/2013 academic session. Purposive sampling was done to select adult participants from varying ethnicities and ages from the list of patients. In-depth interviews were conducted at the participants' homes and were audio recorded. The transcripts of these interviews were analyzed using thematic analysis. A total of nine in-depth interviews were conducted. Four main themes were identified from thematic analysis: 1) Perceived meaning of the visit; 2) Perceived benefits and risks; 3) Past healthcare experiences; 4) Availability for visits. The home visits meant different things to different participants, including a teaching-learning encounter, a social visit, a charitable deed or a healthcare check-up. The benefits and risks of accepting unknown students to their homes and sharing their health issues with them had been weighed prior to participation. Prior experience with healthcare services such as gratitude to healthcare providers or having a relative in the healthcare profession increased their receptivity for involvement. Lastly, enabling factors such as availability of time would determine their acceptance for home visits. Patients agree to participate in medical education activities on a voluntary basis for various reasons. Providing good healthcare service and sufficient preparation are crucial to increase patient receptivity for such activities.

Factors associated with antenatal care adequacy in rural and urban contexts-results from two health and demographic surveillance sites in Vietnam

PubMed Central

2012-01-01

Background Antenatal Care (ANC) is universally considered important for women and children. This study aims to identify factors, demographic, social and economic, possibly associated with three ANC indicators: number of visits, timing of visits and content of services. The aim is also to compare the patterns of association of such factors between one rural and one urban context in northern Vietnam. Methods Totally 2,132 pregnant women were followed from identification of pregnancy until birth in two Health and Demographic Surveillance Sites (HDSS). Information was obtained through quarterly face to face interviews. Results Living in the rural area was significantly associated with lower adequate use of ANC compared to living in the urban area, both regarding quantity (number and timing of visits) and content. Low education, living in poor households and exclusively using private sector ANC in both sites and self employment, becoming pregnant before 25 years of age and living in poor communities in the rural area turned out to increase the risk for overall inadequate ANC. High risk pregnancy could not be demonstrated to be associated with ANC adequacy in either site. The medical content of services offered was often inadequate, in relation to the national recommendations, especially in the private sector. Conclusion Low education, low economic status, exclusive use of private ANC and living in rural areas were main factors associated with risk for overall inadequate ANC use as related to the national recommendations. Therefore, interventions focussing on poor and less educated women, especially in rural areas should be prioritized. They should focus the importance of early attendance of ANC and sufficient use of core services. Financial support for poor and near poor women should be considered. Providers of ANC should be educated and otherwise influenced to provide sufficient core services. Adherence to ANC content guidelines must be improved through enhanced supervision, particularly in the private sector. PMID:22335834

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

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

Not Available

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

Case Study of Home-School Visits

ERIC Educational Resources Information Center

Aguerrebere, Yolanda

2009-01-01

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

Designing a Marketing Course with Field Site Visits

ERIC Educational Resources Information Center

Van Doren, Doris; Corrigan, Hope Bober

2008-01-01

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

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

Expert Panel Reviews of Research Centers: The Site Visit Process

ERIC Educational Resources Information Center

Lawrenz, Frances; Thao, Mao; Johnson, Kelli

2012-01-01

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

Implementation of case studies in undergraduate didactic nursing courses: a qualitative study.

PubMed

Dutra, Danette K

2013-07-04

The implementation of unfolding scenario-based case studies in the didactic classroom is associated with learner-centered education. The utilization of learner-centered pedagogies, such as case studies, removes the focus from the instructor and instead places it on the student. Learner-centered pedagogies are believed to improve students' levels of cognition. The purpose of this study was to examine how nurse educators are implementing the pedagogies of case studies in their undergraduate didactic courses. The goal was to examine, document, report, and, ultimately, implement the strategies. Purposeful sampling was utilized in this qualitative, multisite-designed study. For each of the four participants, three separate site visits were completed. Observations and post-observational interviews took place at each site visit. Transcribed data from interviews, observations, and course documents were imported into the computer program Nvivo8. Repetitive comparative analysis was utilized to complete the data coding process. The guiding research question of this study sought to investigate the implementation strategies of case studies in didactic nursing courses. The implementation of case studies by the participants reflected two primary patterns: Formal Implementation (FI) and Informal Implementation (II) of case studies. The FI of case studies was further divided into two subcategories: Formal Implementation of case studies used Inside the Classroom setting (FIIC) and Formal Implementation of cases studies used Outside of the Classroom (FIOC). Results of this investigation have led to an increased understanding of implementation strategies of unfolding scenario-based case studies in undergraduate nursing didactic courses. Data collected were rich in the description of specific methodologies for utilization of case studies and may serve as a resource for faculty in development of creative strategies to enhance the didactic classroom experience.

Implementation of case studies in undergraduate didactic nursing courses: a qualitative study

PubMed Central

2013-01-01

Background The implementation of unfolding scenario-based case studies in the didactic classroom is associated with learner-centered education. The utilization of learner-centered pedagogies, such as case studies, removes the focus from the instructor and instead places it on the student. Learner-centered pedagogies are believed to improve students’ levels of cognition. The purpose of this study was to examine how nurse educators are implementing the pedagogies of case studies in their undergraduate didactic courses. The goal was to examine, document, report, and, ultimately, implement the strategies. Methods Purposeful sampling was utilized in this qualitative, multisite-designed study. For each of the four participants, three separate site visits were completed. Observations and post-observational interviews took place at each site visit. Transcribed data from interviews, observations, and course documents were imported into the computer program Nvivo8. Repetitive comparative analysis was utilized to complete the data coding process. Results The guiding research question of this study sought to investigate the implementation strategies of case studies in didactic nursing courses. The implementation of case studies by the participants reflected two primary patterns: Formal Implementation (FI) and Informal Implementation (II) of case studies. The FI of case studies was further divided into two subcategories: Formal Implementation of case studies used Inside the Classroom setting (FIIC) and Formal Implementation of cases studies used Outside of the Classroom (FIOC). Conclusion Results of this investigation have led to an increased understanding of implementation strategies of unfolding scenario-based case studies in undergraduate nursing didactic courses. Data collected were rich in the description of specific methodologies for utilization of case studies and may serve as a resource for faculty in development of creative strategies to enhance the didactic classroom experience. PMID:23826925

Evolving food retail environments in Thailand and implications for the health and nutrition transition

PubMed Central

Banwell, Cathy; Dixon, Jane; Seubsman, Sam-ang; Pangsap, Suttinan; Kelly, Matthew; Sleigh, Adrian

2013-01-01

Objective An investigation into evolving food retail systems in Thailand Design Rapid assessment procedures based on qualitative research methods such as interviews, focus groups discussions and site visits Setting Seven freshmarkets located in the four main regions of Thailand Subjects Managers, food specialists, vendors and shoppers from seven freshmarkets who participated in interviews and focus group discussions. Results Freshmarkets are under economic pressure and are declining in number. They are attempting to resist the competition from supermarkets by improving convenience, food diversity, quality and safety. Conclusions Obesity has increased in Thailand at the same time as rapid growth of modern food retail formats has occurred. As freshmarkets are overtaken by supermarkets there is a likely loss of fresh, healthy, affordable food for poorer Thais, and a diminution of regional culinary culture, women’s jobs and social capital with implications for the health and nutrition transition in Thailand. PMID:23021291

Evolving food retail environments in Thailand and implications for the health and nutrition transition.

PubMed

Banwell, Cathy; Dixon, Jane; Seubsman, Sam-Ang; Pangsap, S; Kelly, Matthew; Sleigh, Adrian

2013-04-01

To investigate evolving food retail systems in Thailand. Rapid assessment procedures based on qualitative research methods including interviews, focus groups discussions and site visits. Seven fresh markets located in the four main regions of Thailand. Managers, food specialists, vendors and shoppers from seven fresh markets who participated in interviews and focus group discussions. Fresh markets are under economic pressure and are declining in number. They are attempting to resist the competition from supermarkets by improving convenience, food diversity, quality and safety. Obesity has increased in Thailand at the same time as rapid growth of modern food retail formats has occurred. As fresh markets are overtaken by supermarkets there is a likely loss of fresh, healthy, affordable food for poorer Thais, and a diminution of regional culinary culture, women's jobs and social capital, with implications for the health and nutrition transition in Thailand.

STS-126 crew visit

NASA Technical Reports Server (NTRS)

2009-01-01

Media members interview Commander Christopher Ferguson (right) during his Jan. 13 visit to StenniSphere. He was joined by Mission Specialist Heidemarie Stefanyshyn-Piper (on stage, left), both members of the STS-126 shuttle mission.

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

PubMed

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

2018-02-01

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

Implementing and Preparing for Home Visits

ERIC Educational Resources Information Center

McWilliam, R. A.

2012-01-01

The most common setting for early intervention services for infants and toddlers with disabilities and their families is the home. This article discusses home- and community-based early intervention and how the routines-based interview (RBI) can set the stage for successful home visits. It also addresses what has been learned about home visiting,…

Organizing Sexualities Work at PSU. Forensic Study Visit (November 11-15, 2002).

ERIC Educational Resources Information Center

Sears, James T.

In a 5-day campus visit, a consultant explored the leadership role the College of Education can play in helping the Pennsylvania State University embrace sexual diversity, enhance curricular offerings, promote research and scholarship, and provide outreach services to various constituencies through various media. The visit included interviews with…

Oral health care utilization by US rural residents, National Health Interview Survey 1999.

PubMed

Vargas, Clemencia M; Dye, Bruce A; Hayes, Kathy

2003-01-01

To compare the dental care utilization practices of rural and urban residents in the United States. Data on dental care utilization from the 1999 National Health Interview Survey for persons 2 years of age and older (n=42, 139) were analyzed by rural/urban status. Percentages and 95 percent confidence intervals were calculated to produce national estimates for having had a visit in the past year, the number of visits, reasons given for last dental visit and for not visiting a dentist, unmet dental needs, and private dental insurance. Rural residents were more likely to report that their last dental visit was because something was "bothering or hurting" (23.3% vs 17.6%) and that they had unmet dental needs (10.1% vs 7.5%). Urban residents were more likely to report having a dental visit in the past year (57.7% vs 66.5%) and having private dental insurance (32.7% vs 37.2%), compared to rural residents. There were no significant differences in most reasons given for not visiting the dentist between rural and urban respondents. Dental care utilization characteristics differ between rural and urban residents in the United States, with rural residents tending to underutilize dental care.

Using a programmatic mapping approach to plan for HIV prevention and harm reduction interventions for people who inject drugs in three South African cities.

PubMed

Scheibe, Andrew; Shelly, Shaun; Lambert, Andrew; Schneider, Andrea; Basson, Rudolf; Medeiros, Nelson; Padayachee, Kalvanya; Savva, Helen; Hausler, Harry

2017-06-07

Stigma, criminalisation and a lack of data on drug use contribute to the "invisibility" of people who inject drugs (PWID) and make HIV prevention and treatment service delivery challenging. We aimed to confirm locations where PWID congregate in Cape Town, eThekwini and Tshwane (South Africa) and to estimate PWID population sizes within selected electoral wards in these areas to inform South Africa's first multi-site HIV prevention project for PWID. Field workers (including PWID peers) interviewed community informants to identify suspected injecting locations in selected electoral wards in each city and then visited these locations and interviewed PWID. Interviews were used to gather information about the accessibility of sterile injecting equipment, location coordinates and movement patterns. We used the Delphi method to obtain final population size estimates for the mapped wards based on estimates from wisdom of the crowd methods, the literature and programmatic data. Between January and April 2015, we mapped 45 wards. Tshwane teams interviewed 39 PWID in 12 wards, resulting in an estimated number of accessible PWID ranging from 568 to 1431. In eThekwini, teams interviewed 40 PWID in 15 wards with an estimated number of accessible PWID ranging from 184 to 350. The Cape Town team interviewed 61 PWID in 18 wards with an estimated number of accessible PWID ranging between 398 and 503. Sterile needles were only available at one location. Almost all needles were bought from pharmacies. Between 80 and 86% of PWID frequented more than one location per day. PWID who reported movement visited a median of three locations a day. Programmatic mapping led by PWID peers can be used effectively to identify and reach PWID and build relationships where access to HIV prevention commodities for PWID is limited. PWID reported limited access to sterile injecting equipment, highlighting an important HIV prevention need. Programmatic mapping data show that outreach programmes should be flexible and account for the mobile nature of PWID populations. The PWID population size estimates can be used to develop service delivery targets and as baseline measures.

Study of New Youth Initiatives in Apprenticeship. Interim Report. Volume 2: Site Visit Reports.

ERIC Educational Resources Information Center

CSR, Inc., Washington, DC.

This second volume of the interim report provides detailed case study reports on each of the eight Youth Apprenticeship Projects. (Volume 1, an overview of data from the site visits, is available separately as CE 032 791.) Discussion areas covered in each site visit report are local context/operational environment, administrative information,…

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-22

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

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

EPA Science Inventory

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

Evaluation of the noise pollution in urban parks of Curitiba, Brazil

NASA Astrophysics Data System (ADS)

Ferreira, Andressa C.; Diniz, Fabiano B.; Paz, Elaine C.; Zannin, Paulo T.

2004-05-01

This work shows a study about the noise pollution found in six urban parks of Curitiba, Paran, Brazil. The equivalent noise levels (Leq) have been measured in points spread throughout the park, and interviews have been conducted with some park visitors. It has been found out that 52.48% out of the measurement sites did not satisfy the Municipal Law no. 10,625, which states the noise emission level of 55 dB(A) as the limit value for green areas. The results of the questionnaires applied to the local visitors have showed that 39% out of the interviewed people used to visit the park every day and that 75% out of them seek for the realization of a physical activity. During the realization of their activities in the parks, 22% out of the interviewed people pointed to the noise pollution as the source of annoyance and 28% out of them pointed the local security. In this sense, it has been verified that half of the analyzed parks were inserted in acoustically polluted areas, which incurs a real state depreciation in their vicinities.

Closure Letter Report for Corrective Action Unit 496: Buried Rocket Site - Antelope Lake

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

NSTec Environmental Restoration

A Streamlined Approach for Environmental Restoration (SAFER) Plan for investigation and closure of CAU 496, Corrective Action Site (CAS) TA-55-008-TAAL (Buried Rocket), at the Tonopah Test Range (TTR), was approved by the Nevada Department of Environmental Protection (NDEP) on July 21,2004. Approval to transfer CAS TA-55-008-TAAL from CAU 496 to CAU 4000 (No Further Action Sites) was approved by NDEP on December 21, 2005, based on the assumption that the rocket did not present any environmental concern. The approval letter included the following condition: ''NDEP understands, from the NNSA/NSO letter dated November 30,2005, that a search will be conducted formore » the rocket during the planned characterization of other sites at the Tonopah Test Range and, if found, the rocket will be removed as a housekeeping measure''. NDEP and U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office personnel located the rocket on Mid Lake during a site visit to TTR, and a request to transfer CAS TA-55-008-TAAL from CAU 4000 back to CAU 496 was approved by NDEP on September 11,2006. CAS TA-55-008-TAAL was added to the ''Federal Facility Agreement and Consent Order'' of 1996, based on an interview with a retired TTR worker in 1993. The original interview documented that a rocket was launched from Area 9 to Antelope Lake and was never recovered due to the high frequency of rocket tests being conducted during this timeframe. The interviewee recalled the rocket being an M-55 or N-55 (the M-50 ''Honest John'' rocket was used extensively at TTR from the 1960s to early 1980s). A review of previously conducted interviews with former TTR personnel indicated that the interviewees confused information from several sites. The location of the CAU 496 rocket on Mid Lake is directly south of the TTR rocket launch facility in Area 9 and is consistent with information gathered on the lost rocket during recent interviews. Most pertinently, an interview in 2005 with a former TTR range manager recalled a lost rocket that possibly contained a depleted uranium ballast in an inert warhead. The interviewee confirmed that the last tracking coordinate for the rocket indicated it was lost in an area south of Area 9 near the l T R range coordinates X = 6,614.57 feet (ft) and Y = -20,508.79 ft. These coordinates correspond to a location approximately 2,295 ft northeast of the Mid Target, on Mid Lake. CAS TA-55-008-TAAL was removed from CAU 496 before the SAFER investigation could be completed, and before the new information could be evaluated and the conceptual site model assumptions confirmed.« less

Impact of a brief patient and provider intervention to improve the quality of communication about medication adherence among HIV patients.

PubMed

Beach, Mary Catherine; Roter, Debra L; Saha, Somnath; Korthuis, P Todd; Eggly, Susan; Cohn, Jonathan; Sharp, Victoria; Moore, Richard D; Wilson, Ira B

2015-09-01

Medication adherence is essential in HIV care, yet provider communication about adherence is often suboptimal. We designed this study to improve patient-provider communication about HIV medication adherence. We randomized 26 providers at three HIV care sites to receive or not receive a one-hour communication skills training based on motivational interviewing principles applied to medication adherence. Prior to routine office visits, non-adherent patients of providers who received the training were coached to discuss adherence with their providers. Patients of providers who did not receive the training providers were not coached. We audio-recorded and coded patient-provider interactions using the roter interaction analysis system (RIAS). There was more dialogue about therapeutic regimen in visits with intervention patients and providers (167 vs 128, respectively, p=.004), with the majority of statements coming from providers. These visits also included more brainstorming solutions to nonadherence (41% vs. 22%, p=0.026). Intervention compared with control visit providers engaged in more positive talk (44 vs. 38 statements, p=0.039), emotional talk (26 vs. 18 statements, p<0.001), and probing of patient opinion (3 vs. 2 statements, p=0.009). A brief provider training combined with patient coaching sessions, improved provider communication behaviors and increased dialogue regarding medication adherence. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Falls in residential carpentry and drywall installation: findings from active injury surveillance with union carpenters.

PubMed

Lipscomb, Hester J; Dement, John M; Nolan, James; Patterson, Dennis; Li, Leiming; Cameron, Wilfred

2003-08-01

Active injury surveillance was conducted with a large, unionized workforce of residential and drywall carpenters over a 3-year period. Injured carpenters were interviewed by trained carpenter investigators and sites were visited where falls occurred. Qualitative information was collected on exposures, risk perception, training, and mentoring. Falls accounted for 20% of injuries. Same-level falls were often related to weather, carrying objects-sometimes with an obstructed view-housekeeping, terrain of the lot, and speed of work. Falls from height occurred from a variety of work surfaces and involved ladders, scaffolding, roofs, work on other unsecured surfaces, unprotected openings, speed, and weather conditions. Recognized fall protection strategies, such as guardrails, toe boards, tying off to appropriate anchors, and guarding openings, would have prevented many of these falls; these practices were not the norm on many sites.

Revealing teacher agendas: An examination of teacher motivations and strategies for conducting museum fieldtrips

NASA Astrophysics Data System (ADS)

Kisiel, James Francis

The purpose of this investigation was to identify the motivations and strategies that comprise teachers' agendas when leading a student fieldtrip to a museum or similar site. Two data collection methods were used. A survey regarding field trip experiences and rationale was mailed to upper elementary teachers, resulting in a variety of open-ended responses that were analyzed and coded to identify recurring themes. In addition, ten teachers accompanying students during a school trip to a natural history museum were interviewed and observed. Data collected from these in-depth studies were used to verify findings from the survey instrument and to refine and enhance the definitions and descriptions of actual practice. Eight fieldtrip motivations were identified including to connection with the classroom curriculum, to provide a general learning experience, to encourage lifelong learning, to enhance interest and motivation, to provide exposure to new experiences, to provide a change in setting or routine, for enjoyment, and to meet school expectations. Fieldtrip strategies used by teachers could be divided into pre-visit, during-visit or post-visit strategies. The commonly reported pre-visit strategies included familiarization and supervision preparation. During-visit strategies focused on structured student engagement strategies (such as worksheets or guided tours) and unstructured strategies (such as interpretation, connecting, facilitation, label-reading, advance organizers and free exploration), as well as event documentation and supervision tactics (such as keeping track and refocusing). Post-visit strategies included review and discussion, documentation , and assessment. Comparison of stated motivations and observed strategies revealed few links. However, results indicated that connecting to the classroom curriculum was an important consideration, even though teachers had different interpretations of what this meant. Providing hands-on experiences was also critical for many teachers, although the meaning of "hands-on" was more closely related to authentic experience rather than a component of inquiry-based learning. Further examination of the teachers' agendas suggested the influence of contexts, including that of the school (restrictions, curricular pressures), the teacher's personal context (teaching and museum experiences), and the museum site itself. These findings lead to suggestions through which museums might better facilitate school visits by considering the contexts that influence the teachers' fieldtrip perspectives and agendas.

Effects of Site Visits on Innovation Adoption.

ERIC Educational Resources Information Center

Fleischer, Mitchell

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

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Reporting From the Front Lines: Implementing Oregon's Alternative Payment Methodology in Federally Qualified Health Centers.

PubMed

Cottrell, Erika K; Hall, Jennifer D; Kautz, Glenn; Angier, Heather; Likumahuwa-Ackman, Sonja; Sisulak, Laura; Keller, Sara; Cameron, David C; DeVoe, Jennifer E; Cohen, Deborah J

Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. We conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations that were part of Oregon's Alternative Payment Methodology demonstration project. Data were analyzed using an immersion-crystallization approach. We identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment. Future research is needed to further understand the implications of these changes.

The role of state mental health authorities in managing change for the implementation of evidence-based practices.

PubMed

Isett, Kimberley Roussin; Burnam, M Audrey; Coleman-Beattie, Brenda; Hyde, Pamela S; Morrissey, Joseph P; Magnabosco, Jennifer L; Rapp, Charles; Ganju, Vijay; Goldman, Howard H

2008-06-01

The evidence-based practice demonstration for services to adults with serious mental illness has ended its pilot stage. This paper presents the approaches states employed to combine traditional policy levers with more strategic/institutional efforts (e.g., leadership) to facilitate implementation of these practices. Two rounds of site visits were completed and extensive interview data collected. The data were analyzed to find trends that were consistent across states and across practices. Two themes emerged for understanding implementation of evidence-based practices: the support and influence of the state mental health authority matters and so does the structure of the mental health systems.

Children's Perceptions of Plants Following Their Visit to the Eden Project

ERIC Educational Resources Information Center

Bowker, Rob

2004-01-01

The study described is part of a larger research programme designed to investigate primary aged children's learning during a visit to the Eden Project. Children from eight primary schools were interviewed approximately four weeks after a one-day, teacher-led visit to the Eden Project (EP) in Cornwall. Their responses revealed that the children…

Safety analysis and review system (SARS) assessment report

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

Browne, E.T.

1981-03-01

Under DOE Order 5481.1, Safety Analysis and Review System for DOE Operations, safety analyses are required for DOE projects in order to ensure that: (1) potential hazards are systematically identified; (2) potential impacts are analyzed; (3) reasonable measures have been taken to eliminate, control, or mitigate the hazards; and (4) there is documented management authorization of the DOE operation based on an objective assessment of the adequacy of the safety analysis. This report is intended to provide the DOE Office of Plans and Technology Assessment (OPTA) with an independent evaluation of the adequacy of the ongoing safety analysis effort. Asmore » part of this effort, a number of site visits and interviews were conducted, and FE SARS documents were reviewed. The latter included SARS Implementation Plans for a number of FE field offices, as well as safety analysis reports completed for certain FE operations. This report summarizes SARS related efforts at the DOE field offices visited and evaluates the extent to which they fulfill the requirements of DOE 5481.1.« less

Cross-cultural comparison of long-term care in the United States and Finland: Research done through a short-term study-abroad experience.

PubMed

Kruger, Tina M; Gilland, Sarah; Frank, Jacquelyn B; Murphy, Bridget C; English, Courtney; Meade, Jana; Morrow, Kaylee; Rush, Evan

2017-01-01

In May 2014, a short-term study-abroad experience was conducted in Finland through a course offered at Indiana State University (ISU). Students and faculty from ISU and Eastern Illinois University participated in the experience, which was created to facilitate a cross-cultural comparison of long-term-care settings in the United States and Finland. With its outstanding system of caring for the health and social needs of its aging populace, Finland is a logical model to examine when considering ways to improve the quality of life for older adults who require care in the United States . Those participating in the course visited a series of long-term-care facilities in the region surrounding Terre Haute, Indiana, then travelled to Lappeenranta, Finland to visit parallel sites. Through limited-participation observation and semistructured interviews, similarities and differences in experiences, educations, and policies affecting long-term care workers in the United States and Finland were identified and are described here.

Evaluating the Implementation of Home-Based Videoconferencing for Providing Mental Health Services.

PubMed

Interian, Alejandro; King, Arlene R; St Hill, Lauren M; Robinson, Claire H; Damschroder, Laura J

2018-01-01

The Veterans Health Administration (VHA) has recently implemented video-to-home (V2H) telehealth as part of a strategy to improve access to mental health treatment. Implementation research of this modality is needed, given that V2H telehealth transforms the traditional face-to-face delivery of mental health services. To address this need, V2H implementation was evaluated by examining barriers and facilitators that were associated with level of staff V2H experience and factors that differentiated facilities with various levels of V2H performance. Semistructured interviews with VHA personnel (N=33) from three facilities were conducted. The facilities were selected by overall number of mental health V2H visits during fiscal year (FY) 2015 as well as by growth in number of visits from FY 2014 through FY 2015. Factors influencing implementation were identified through qualitative analyses that contrasted responses by groups of participants with three different levels of V2H experience (no experience, limited experience, most experience) as well as three facilities that differed in V2H productivity (high visit count, high visit growth, and low visit count and low visit growth). Providers seemed to encounter different barriers and facilitators depending on their level of experience with V2H. Site-level analyses illustrated the importance of logistical support, especially for providers who are newly adopting the technology. Other factors that differentiated the facilities were also identified and described. Key factors related to implementation of V2H telehealth pertained to provider buy-in and logistical support. Facility-level strategies that address these factors may enhance provider progression from nonuse to sustained use.

Intention to Discontinue Care Among Primary Care Patients

PubMed Central

Federman, Alex D; Cook, E Francis; Phillips, Russell S; Puopolo, Ann Louise; Haas, Jennifer S; Brennan, Troyen A; Burstin, Helen R

2001-01-01

BACKGROUND Specific elements of health care process and physician behavior have been shown to influence disenrollment decisions in HMOs, but not in outpatient settings caring for patients with diverse types of insurance coverage. OBJECTIVE To examine whether physician behavior and process of care affect patients' intention to return to their usual health care practice. DESIGN Cross-sectional patient survey and medical record review. SETTING Eleven academically affiliated primary care medicine practices in the Boston area. PATIENTS 2,782 patients with at least one visit in the preceding year. MEASUREMENT Unwillingness to return to the usual health care practice. RESULTS Of the 2,782 patients interviewed, 160 (5.8%) indicated they would not be willing to return. Two variables correlated significantly with unwillingness to return after adjustment for demographics, health status, health care utilization, satisfaction with physician's technical skill, site of care, and clustering of patients by provider: dissatisfaction with visit duration (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4 to 7.4) and patient reports that the physician did not listen to what the patient had to say (OR, 8.8; 95% CI, 2.5 to 30.7). In subgroup analysis, patients who were prescribed medications at their last visit but who did not receive an explanation of the purpose of the medication were more likely to be unwilling to return (OR, 4.9; 95% CI, 1.8 to 13.3). CONCLUSION Failure of physicians to acknowledge patient concerns, provide explanations of care, and spend sufficient time with patients may contribute to patients' decisions to discontinue care at their usual site of care. PMID:11679034

Instructions for Using Traffic Counters to Estimate Recreation Visits and Use

Treesearch

George A. James; Thomas H. Ripley

1963-01-01

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

Organizational and Teamwork Factors of Tele-Intensive Care Units.

PubMed

Wilkes, Michael S; Marcin, James P; Ritter, Lois A; Pruitt, Sherilyn

2016-09-01

Use of tele-intensive care involves organizational and teamwork factors across geographic locations. This situation adds to the complexity of collaboration in providing quality patient-centered care. To evaluate cross-agency teamwork of health care professionals caring for patients in tele-intensive care units in rural and urban regions. A national qualitative study was conducted in 3 US geographic regions with tele-intensive care programs. Discussions and interviews were held with key participants during site visits at 3 hub sites (specialist services location) and 8 rural spoke sites (patient location). The effects of communication and culture between the hub team and the spoke team on use of the services and effectiveness of care were evaluated. A total of 34 participants were interviewed. Specific organizational and teamwork factors significantly affect the functionality of a tele-intensive care unit. Key operational and cultural barriers that limit the benefits of the units include unrealistic expectations about operational capabilities, lack of trust, poorly defined leadership, and a lack of communication policies. Potential solutions include education on spoke facility resources, clearly defined expectations and role reversal education, team-building activities, and feedback mechanisms to share concerns, successes, and suggestions. Proper administration and attention to important cultural and teamwork factors are essential to making tele-intensive care units effective, practical, and sustainable. ©2016 American Association of Critical-Care Nurses.

The use of open source electronic health records within the federal safety net.

PubMed

Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

2014-01-01

To conduct a federally funded study that examines the acquisition, implementation and operation of open source electronic health records (EHR) within safety net medical settings, such as federally qualified health centers (FQHC). The study was conducted by the National Opinion Research Center (NORC) at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to West Virginia, California and Arizona FQHC that were currently using an open source EHR. Five of the six sites that were chosen as part of the study found a number of advantages in the use of their open source EHR system, such as utilizing a large community of users and developers to modify their EHR to fit the needs of their provider and patient communities, and lower acquisition and implementation costs as compared to a commercial system. Despite these advantages, many of the informants and site visit participants felt that widespread dissemination and use of open source was restrained due to a negative connotation regarding this type of software. In addition, a number of participants stated that there is a necessary level of technical acumen needed within the FQHC to make an open source EHR effective. An open source EHR provides advantages for FQHC that have limited resources to acquire and implement an EHR, but additional study is needed to evaluate its overall effectiveness.

A time-motion study of cardiovascular disease risk factor screening integrated into HIV clinic visits in Swaziland.

PubMed

Palma, Anton M; Rabkin, Miriam; Simelane, Samkelo; Gachuhi, Averie B; McNairy, Margaret L; Nuwagaba-Biribonwoha, Harriet; Bongomin, Pido; Okello, Velephi N; Bitchong, Raymond A; El-Sadr, Wafaa M

2018-03-01

Screening of modifiable cardiovascular disease (CVD) risk factors is recommended but not routinely provided for HIV-infected patients, especially in low-resource settings. Potential concerns include limited staff time and low patient acceptability, but little empirical data exists. As part of a pilot study of screening in a large urban HIV clinic in Swaziland, we conducted a time-motion study to assess the impact of screening on patient flow and HIV service delivery and exit interviews to assess patient acceptability. A convenience sample of patients ≥40 years of age attending routine HIV clinic visits was screened for hypertension, diabetes, hyperlipidemia and tobacco smoking. We observed HIV visits with and without screening and measured time spent on HIV and CVD risk factor screening activities. We compared screened and unscreened patients on total visit time and time spent receiving HIV services using Wilcoxon rank-sum tests. A separate convenience sample of screened patients participated in exit interviews to assess their satisfaction with screening. We observed 172 patient visits (122 with CVD risk factor screening and 50 without). Screening increased total visit time from a median (range) of 4 minutes (2 to 11) to 15 minutes (9 to 30) (p < 0.01). Time spent on HIV care was not affected: 4 (2 to 10) versus 4 (2 to 11) (p = 0.57). We recruited 126 patients for exit interviews, all of whom indicated that they would recommend screening to others. Provision of CVD risk factor screening more than tripled the length of routine HIV clinic visits but did not reduce the time spent on HIV services. Programme managers need to take longer visit duration into account in order to effectively integrate CVD risk factor screening and counselling into HIV programmes. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Private dental visits per dentist in Spain from 1987 to 1997. An analysis from the Spanish national Health Interview Surveys.

PubMed

Bravo, Manuel

2002-10-01

In view of the sharp increase in the number of dentists in Spain, the aim of the present study was to analyse changes in the private dentist workload in Spain over the period 1987-97. Data were taken from censuses of the population and of dental practitioners, and from the Spanish National Health Interview Surveys. The percentage of people that had visited the dentist in the 3 months prior to the survey was calculated, and of these, the percentage whose last visit was private. The total number of visits made by those people was taken as the estimate of total private visits in Spain during 3 months. Total private activity in 1 year was derived by multiplying this estimate by four. Annual private activity was then divided by the number of dentists. From 1987 to 1997, the Spanish population grew 2.5% (from 38.7 to 39.7 million) and the number of dentists increased by 136.1% (from 6373 to 15,044). The total annual number of private dental visits (+/-SE) was 35.7 +/- 1.0 million in 1987, and 48.9 +/- 2.0 million in 1997 - a 36.8% increase. Thus, the mean number of private dental visits per dentist decreased 42.0% (from 5610 +/- 152 to 3251 +/- 133). A significant reduction in private dental visits per dentist is taking place in Spain.

28 CFR 540.61 - Authorization.

Code of Federal Regulations, 2011 CFR

2011-07-01

... news organization which he or she represents, permission to conduct an interview. (g) Any questions as... who desires to make a visit or conduct an interview at an institution must make application in writing... institution and agrees to comply with them. (b) As a condition of authorizing interviews and making facilities...

28 CFR 540.61 - Authorization.

Code of Federal Regulations, 2010 CFR

2010-07-01

... news organization which he or she represents, permission to conduct an interview. (g) Any questions as... who desires to make a visit or conduct an interview at an institution must make application in writing... institution and agrees to comply with them. (b) As a condition of authorizing interviews and making facilities...

Language and Intercultural Education: An Interview with Michael Byram

ERIC Educational Resources Information Center

Porto, Melina

2013-01-01

This article reports an interview with Michael Byram, Professor Emeritus, University of Durham in the United Kingdom, during his visit to Argentina in September 2011. Michael Byram is one of the main international referents in intercultural education. The interview addresses issues such as language education, intercultural and citizenship…

After-visit summaries in primary care: mixed methods results from a literature review and stakeholder interviews.

PubMed

Lyles, Courtney R; Gupta, Reena; Tieu, Lina; Fernandez, Alicia

2018-05-28

After-visit summary (AVS) documents presenting key information from each medical encounter have become standard in the USA due to federal health care reform. Little is known about how they are used or whether they improve patient care. First, we completed a literature review and described the totality of the literature on AVS by article type and major outcome measures. Next, we used reputational sampling from large-scale US studies on primary care to identify and interview nine stakeholders on their perceptions of AVS across high-performing primary care practices. Interviews were transcribed and coded for AVS use in practice, perceptions of the best/worst features and recommendations for improving AVS utility in routine care. The literature review resulted in 17 studies; patients reported higher perceived value of AVS compared with providers, despite poor recall of specific AVS content and varied post-visit use. In key informant interviews, key informants expressed enthusiasm for the potential of using AVS to reinforce key information with patients, especially if AVS were customizable. Despite this potential, key informants found that AVS included incorrect information and did not feel that patients or their practices were using AVS to enhance care. There is a gap between the potential of AVS and how providers and patients are using it in routine care. Suggestions for improved use of AVS include increasing customization, establishing care team responsibilities and workflows and ensuring patients with communication barriers have dedicated support to review AVS during visits.

Home visits for frail older people: a qualitative study on the needs and preferences of frail older people and their informal caregivers.

PubMed

van Kempen, Janneke A L; Robben, Sarah H M; Zuidema, Sytse U; Olde Rikkert, Marcel G M; Melis, René J F; Schers, Henk J

2012-08-01

A number of studies have examined the effects of home visits and showed inconsistent results on physical functioning, institutionalisation, and mortality. Despite continuing interest from professionals in home visits for older people, reports on older people's needs and preferences for such visits are scarce. This qualitative study aims to explore the views and needs of community-dwelling frail older people concerning home visits. A qualitative study including interviews with frail older persons and their informal caregivers living in the area of Nijmegen, the Netherlands. Semi-structured interviews were conducted with frail older people and informal caregivers. A grounded theory approach was used for data-analysis. Eleven frail older people and 11 informal caregivers were included. Most participants emphasised the importance of home visits for frail older people. They felt that it would give older people the personal attention they used to receive from GPs but miss nowadays. Most stated that this would give them more trust in GPs. Participants stated that trust is one of the most important factors in a good patient-professional relationship. Further, participants preferred home visits to focus on the psychosocial context of the patient. They stated that more knowledge of the psychosocial context and a good patient-professional relationship would enable the professional to provide better and more patient-centred care. Patients' expectations of home visits are quite different from the actual purpose of home visiting programmes; that is, care and wellbeing versus cure and prevention. This difference may partly explain why the effectiveness of home visits remains controversial. Future studies on home visits should involve patients in the development of home visiting programmes.

Adolescent substance use screening in primary care: validity of computer self-administered vs. clinician-administered screening

PubMed Central

Harris, Sion Kim; Knight, John R; Van Hook, Shari; Sherritt, Lon; Brooks, Traci; Kulig, John W; Nordt, Christina; Saitz, Richard

2015-01-01

Background Computer self-administration may help busy pediatricians’ offices increase adolescent substance use screening rates efficiently and effectively, if proven to yield valid responses. The CRAFFT screening protocol for adolescents has demonstrated validity as an interview, but a computer self-entry approach needs validity testing. The aim of this study was to evaluate the criterion validity and time efficiency of a computerized adolescent substance use screening protocol implemented by self-administration or clinician-administration. Methods 12- to 17-year-old patients coming for routine care at three primary care clinics completed the computerized screen by both self-administration and clinician-administration during their visit. To account for order effects, we randomly assigned participants to self-administer the screen either before or after seeing their clinician. Both were conducted using a tablet computer and included identical items (any past-12-month use of tobacco, alcohol, drugs; past-3-months frequency of each; and six CRAFFT items). The criterion measure for substance use was the Timeline Follow-Back, and for alcohol/drug use disorder, the Adolescent Diagnostic Interview, both conducted by confidential research assistant-interview after the visit. Tobacco dependence risk was assessed with the self-administered Hooked on Nicotine Checklist (HONC). Analyses accounted for the multi-site cluster sampling design. Results Among 136 participants, mean age was 15.0±1.5 yrs, 54% were girls, 53% were Black or Hispanic, and 67% had ≥3 prior visits with their clinician. Twenty-seven percent reported any substance use (including tobacco) in the past 12 months, 7% met criteria for an alcohol or cannabis use disorder, and 4% were HONC-positive. Sensitivity/specificity of the screener were high for detecting past-12-month use or disorder and did not differ between computer and clinician. Mean completion time was 49 seconds (95%CI 44-54) for computer and 74 seconds (95%CI 68-87) for clinician (paired comparison p<0.001). Conclusions Substance use screening by computer self-entry is a valid and time-efficient alternative to clinician-administered screening. PMID:25774878

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

PubMed

Custers, Kathleen; Van den Bulck, Jan

2009-05-01

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

FIELD STUDIES OF GEOMEMBRANE INSTALLATION TECHNIQUES

EPA Science Inventory

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

Interpersonal Privacy Management in Distributed Collaboration: Situational Characteristics and Interpretive Influences

NASA Astrophysics Data System (ADS)

Patil, Sameer; Kobsa, Alfred; John, Ajita; Brotman, Lynne S.; Seligmann, Doree

To understand how collaborators reconcile the often conflicting needs of awareness and privacy, we studied a large software development project in a multinational corporation involving individuals at sites in the U.S. and India. We present a theoretical framework describing privacy management practices and their determinants that emerged from field visits, interviews, and questionnaire responses. The framework identifies five relevant situational characteristics: issue(s) under consideration, physical place(s) involved in interaction(s), temporal aspects, affordances and limitations presented by technology, and nature of relationships among parties. Each actor, in turn, interprets the situation based on several simultaneous influences: self, team, work site, organization, and cultural environment. This interpretation guides privacy management action(s). Past actions form a feedback loop refining and/or reinforcing the interpretive influences. The framework suggests that effective support for privacy management will require that designers follow a socio-technical approach incorporating a wider scope of situational and interpretive differences.

Visiting Mom: A pilot evaluation of a prison-based visiting program serving incarcerated mothers and their minor children.

PubMed

Schubert, Erin C; Duininck, Megan; Shlafer, Rebecca J

2016-01-01

We describe an evaluation of a prison visiting program, Extended Visiting (EV), for incarcerated mothers and their children. Mothers ( N = 24) and caregivers ( N = 19) were interviewed regarding experiences with the program. Mothers identified benefits including maintaining a relationship with children, physical contact, motivation, privacy, peer support, and personal growth. Caregivers echoed mothers' appreciation for the opportunity to maintain mother-child relationships and physical contact. Mothers identified barriers including desire for overnight visits and more age-appropriate activities. Caregivers perceived travel time and costs and children's adverse reactions as barriers. When comparing EV to typical visiting, participants unanimously preferred EV.

Impact of an informal learning science camp on urban, low socioeconomic status middle school students and participating teacher-leaders

NASA Astrophysics Data System (ADS)

Votaw, Nikki L.

Studies suggest that students have difficulty connecting science to their own lives (Lee & Fradd, 1998; Aikenhead, 1996). This difficulty results in a decline in students' attitudes toward science, leading to low science achievement. These factors result in fewer students interested in careers related to science, specifically for urban, minority students. The purpose of this study was to examine the impact that a ten day informal learning immersion science camp had on the participants, both urban, low-socioeconomic status middle school students and teacher-leaders. The students were incoming seventh grade students involved in a community-based scholar program designed to recruit and support socioeconomically disadvantaged, academically talented students. The teacher-leaders were professional educators working toward an advanced degree. This ten day camp included seven visits to different sites and complementary classroom-based activities. The purpose of the camp was to immerse the students in informal learning environments that affect their daily lives. Students and teacher-leaders visited facilities that provide public utility services (i.e. power plant, sewage treatment facility, and water company), zoo, large commercial cave system, planetarium, university based electrooptics and nanotechnology center, and forest and arboretum. These site visits were supported by activities that were provided by teacher-leaders. A model used as a framework for studying learning in the context of this ten day camp as Falk and Dierking's (2000) Contextual Model for Learning. This model described three basic intersecting elements that contributed to learning within the given context. The three contexts (personal, sociocultural, and physical) intersect affecting the learning that takes place. A mixed methodology design was employed to determine the impact of the camp on students' content knowledge and attitudes toward science. Qualitative data were collected to determine the impact of the camp on teacher-leaders' content knowledge and pedagogy. A variety of data sources were used including data collected before, during, and immediately following the camp as well as data collected several months after the conclusion of the camp. Results of the study indicated that both students and teacher-leaders were positively impacted by their experience at the camp. Data from the content assessments, interviews, and student journals indicate that students' content knowledge was enhanced and expanded through the learning of factual knowledge as well as understanding of the importance of broad scientific processes. Through their new experiences, students developed an awareness of the natural world and a foundation for future learning. Students also developed an awareness of science as it applies to their own lives. Data from students' letters to themselves, student interviews, and parent focus groups indicated that students' attitudes toward science were positively impacted through development of an increased resource appreciation, positive social experiences, and experiential sharing with others. Teacher-leader experiences with the camp also had positive results. Teacher-leaders entered the camp with a variety of unique personal contexts, and in spite of this variability each reported that this was a value-added experience for their teaching. These personal contexts helped to enhance the sociocultural context which provided a rich environment to support teacher-leader learning. Among the pedagogical impacts, teacher-leaders expressed enhanced teaching capacity through acquisition of: new classroom activities; new connections among science content; new stories and experiences to share with future classes; and new contexts for situating the understanding of science principles. Along with the positive impacts, teacher-leaders also identified and articulated several barriers to implementing site visits in their own classrooms. This camp is unique in that it is an immersion experience within informal learning contexts where seven sites were visited within ten days. It is also unique in that students and teacher-leaders were simultaneously experiencing most of these sites for the first time. This study has implications for science camp coordinators (i.e. university faculty), classroom teachers, and informal educators (i.e. museum, zoo, planetarium).

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

NASA Technical Reports Server (NTRS)

2001-01-01

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

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

PubMed

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

2006-12-01

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

75 FR 46899 - Agency Information Collection Activities: Proposed Collection; Comment Request-In-Depth Case...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-04

... conduct interviews of SNAP staff at all levels, visit multiple local offices, hold focus groups with... vendors that contract with State SNAP agencies. Tailored protocols will be used for the interviews... States will receive remuneration of $75,000 to offset the costs of participating in the study. Interview...

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

PubMed

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

2017-09-13

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

Mothers’ experiences in the Nurse-Family Partnership program: a qualitative case study

PubMed Central

2012-01-01

Background Few studies have explored the experiences of low income mothers participating in nurse home visiting programs. Our study explores and describes mothers' experiences participating in the Nurse-Family Partnership (NFP) Program, an intensive home visiting program with demonstrated effectiveness, from the time of program entry before 29 weeks gestation until their infant's first birthday. Methods A qualitative case study approach was implemented. A purposeful sample of 18 low income, young first time mothers participating in a pilot study of the NFP program in Hamilton, Ontario, Canada partook in one to two face to face in-depth interviews exploring their experiences in the program. All interviews were digitally recorded and transcribed verbatim. Conventional content analysis procedures were used to analyze all interviews. Data collection and initial analysis were implemented concurrently. Results The mothers participating in the NFP program were very positive about their experiences in the program. Three overarching themes emerged from the data: 1. Getting into the NFP program; 2. The NFP nurse is an expert, but also like a friend providing support; and 3. Participating in the NFP program is making me a better parent. Conclusions Our findings provide vital information to home visiting nurses and to planners of home visiting programs about mothers' perspectives on what is important to them in their relationships with their nurses, how nurses and women are able to develop positive therapeutic relationships, and how nurses respond to mothers' unique life situations while home visiting within the NFP Program. In addition our findings offer insights into why and under what circumstances low income mothers will engage in nurse home visiting and how they expect to benefit from their participation. PMID:22953748

Reduction in inappropriate prevention of urinary tract infections in long-term care facilities.

PubMed

Rummukainen, Maija-Liisa; Jakobsson, Aino; Matsinen, Maire; Järvenpää, Salme; Nissinen, Antti; Karppi, Pertti; Lyytikäinen, Outi

2012-10-01

Urinary tract infection (UTI) is the most common diagnosis made in prescribing antimicrobials in long-term care facilities (LTCF). The diagnostic criteria for UTI vary among institutions and prescribers. Our aim was to reduce the inappropriate use of antimicrobials in LTCFs. A team comprising infectious disease consultant, infection control nurse, and geriatrician visited all LTCFs for older persons (2,321 patients in 25 primary care hospitals and 39 nursing homes and dementia units) in the Central Finland Healthcare District (population 267,000) during 2004-2005. The site visits consisted of a structured interview concerning patients, ongoing systematic antimicrobials, and diagnostic practices for UTI. Following the visits, regional guidelines for prudent use of antimicrobials in LTCFs were published, and the use of antimicrobials was followed up by an annual questionnaire. The proportions of patients receiving antimicrobials in 2005, 2006, 2007, and 2008 were 19.9%, 16.9%, 16.2%, and 15.4%, respectively. Most of the antibiotics were used for UTI (range by year, 66.6%-81.1%). From 2005 through 2008, the proportion of patients on antibiotic prophylaxis for UTI decreased from 13% to 6%. The decrease was statistically significant in both types of settings. The visits and guidelines were associated with a reduction in the usage of antimicrobials. To sustain this, UTI surveillance and close collaboration between infection control experts and LTCFs are crucial. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

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

PubMed

Lawrenz, Frances; Thao, Mao; Johnson, Kelli

2012-08-01

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

Science Translator: An Interview with Louisa Stark.

PubMed

Stark, Louisa A

2015-07-01

The Genetics Society of America's Elizabeth W. Jones Award for Excellence in Education recognizes significant and sustained impact on genetics education. The 2015 awardee, Louisa Stark, has made a major impact on global access to genetics education through her work as director of the University of Utah Genetic Science Learning Center. The Center's Learn.Genetics and Teach.Genetics websites are the most widely used online genetic education resources in the world. In 2014, they were visited by 18 million students, educators, scientists, and members of the public. With over 60 million page views annually, Learn.Genetics is among the most used sites on the Web. Copyright © 2015 by the Genetics Society of America.

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

PubMed

Dugdill, Lindsey; Pine, Cynthia M

2011-08-01

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

Hypertension management in rural primary care facilities in Zambia: a mixed methods study.

PubMed

Yan, Lily D; Chirwa, Cindy; Chi, Benjamin H; Bosomprah, Samuel; Sindano, Ntazana; Mwanza, Moses; Musatwe, Dennis; Mulenga, Mary; Chilengi, Roma

2017-02-03

Improved primary health care is needed in developing countries to effectively manage the growing burden of hypertension. Our objective was to evaluate hypertension management in Zambian rural primary care clinics using process and outcome indicators to assess the screening, monitoring, treatment and control of high blood pressure. Better Health Outcomes through Mentoring and Assessment (BHOMA) is a 5-year, randomized stepped-wedge trial of improved clinical service delivery underway in 46 rural Zambian clinics. Clinical data were collected as part of routine patient care from an electronic medical record system, and reviewed for site performance over time according to hypertension related indicators: screening (blood pressure measurement), management (recorded diagnosis, physical exam or urinalysis), treatment (on medication), and control. Quantitative data was used to develop guides for qualitative in-depth interviews, conducted with health care providers at a proportional sample of half (20) of clinics. Qualitative data was iteratively analyzed for thematic content. From January 2011 to December 2014, 318,380 visits to 46 primary care clinics by adults aged ≥ 25 years with blood pressure measurements were included. Blood pressure measurement at vital sign screening was initially high at 89.1% overall (range: 70.1-100%), but decreased to 62.1% (range: 0-100%) by 48 months after intervention start. The majority of hypertensive patients made only one visit to the clinics (57.8%). Out of 9022 patients with at least two visits with an elevated blood pressure, only 49.3% had a chart recorded hypertension diagnosis. Process indicators for monitoring hypertension were <10% and did not improve with time. In in-depth interviews, antihypertensive medication shortages were common, with 15/20 clinics reporting hydrochlorothiazide-amiloride stockouts. Principal challenges in hypertension management included 1) equipment and personnel shortages, 2) provider belief that multiple visits were needed before official management, 3) medication stock-outs, leading to improper prescriptions and 4) poor patient visit attendance. Our findings suggest that numerous barriers stand in the way of hypertension diagnosis and management in Zambian primary health facilities. Future work should focus on performance indicator development and validation in low resource contexts, to facilitate regular and systematic data review to improve patient outcomes. ClinicalTrials.gov, Identifier NCT01942278 . Date of Registration: September 2013.

7 CFR 3015.94 - Site visits.

Code of Federal Regulations, 2010 CFR

2010-01-01

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

Assessment of the Effectiveness of Protected Areas Management in Iran: Case Study in Khojir National Park

NASA Astrophysics Data System (ADS)

Kolahi, Mahdi; Sakai, Tetsuro; Moriya, Kazuyuki; Makhdoum, Majid F.; Koyama, Lina

2013-08-01

The requirement to assess the management effectiveness (ME) in protected areas (PAs) is increasing around the world to help improve management and accountability. An evaluation of ME for Khojir National Park (KNP), one of the Iran's oldest PAs, was conducted using a multi-method approach that consisted of structured interviews, open interviews, and site visits. This was the first ME evaluation in Iran. The structured interview was based on the management effectiveness tracking tool methodology. KNP received an average score of 43 %, which is lower than the global average, illustrating that its general management was in the low-intermediate level. The indices of legal status, resource inventory, planning for land and water use, regulations, and objectives received the highest average scores, whereas education and awareness, community co-management, regular work plan, boundary demarcation, visitor facilities, budget sources, staff training, protection systems, and management plan received the lowest ones. The management system of KNP was generally established, but many problems of the management still need to be resolved. To improve ME, some countermeasures should be taken, such as increasing funding, strengthening capacity building, planning, and adaptive management, and implementing community participation.

Father Attendance in Nurse Home Visitation

PubMed Central

Holmberg, John R.; Olds, David L.

2015-01-01

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

A diaper bank and home visiting partnership: Initial exploration of research and policy questions.

PubMed

Sadler, Lois S; Condon, Eileen M; Deng, Shirley Z; Ordway, Monica Roosa; Marchesseault, Crista; Miller, Andrea; Alfano, Janet Stolfi; Weir, Alison M

2018-03-01

The cost of diapering an infant can place a significant financial strain on families living in poverty. Partnerships between diaper banks and home visiting programs for young families may offer an innovative solution to expanding the reach and impact of diaper banks in low-income communities. The purpose of this pilot study was to uncover preliminary information about the functions of diaper distribution through home visiting programs, and to inform future research and policy questions regarding diaper distribution to families in need. In this descriptive qualitative pilot study, semi-structured interviews were conducted with 6 home visitors from Minding the Baby ® (MTB), a home visiting intervention for young parents. MTB clinicians routinely distribute diapers in partnership with The Diaper Bank in Connecticut. We used directed content analysis to code and analyze interview transcripts. These preliminary findings indicate that partnerships between home visiting programs and diaper banks may benefit families by improving diaper access, reducing stigma, and fostering trusting relationships with home visitors. Home visiting program benefits including engagement or re-engagement with families may need to be balanced with potential effects on clinical and therapeutic relationships. Recommendations for next steps in research and related policy questions are discussed. © 2017 Wiley Periodicals, Inc.

A diaper bank and home visiting partnership: Initial exploration of research and policy questions

PubMed Central

Sadler, Lois S.; Condon, Eileen M.; Deng, Shirley Z.; Ordway, Monica Roosa; Marchesseault, Crista; Miller, Andrea; Alfano, Janet Stolfi; Weir, Alison M.

2018-01-01

Objectives The cost of diapering an infant can place a significant financial strain on families living in poverty. Partnerships between diaper banks and home visiting programs for young families may offer an innovative solution to expanding the reach and impact of diaper banks in low-income communities. The purpose of this pilot study was to uncover preliminary information about the functions of diaper distribution through home visiting programs, and to inform future research and policy questions regarding diaper distribution to families in need. Design and Sample In this descriptive qualitative pilot study, semi-structured interviews were conducted with 6 home visitors from Minding the Baby® (MTB), a home visiting intervention for young parents. MTB clinicians routinely distribute diapers in partnership with The Diaper Bank in Connecticut. We used directed content analysis to code and analyze interview transcripts. Results/Conclusion These preliminary findings indicate that partnerships between home visiting programs and diaper banks may benefit families by improving diaper access, reducing stigma, and fostering trusting relationships with home visitors. Home visiting program benefits including engagement or re-engagement with families may need to be balanced with potential effects on clinical and therapeutic relationships. Recommendations for next steps in research and related policy questions are discussed. PMID:29235668

Restaurant Food Allergy Practices - Six Selected Sites, United States, 2014.

PubMed

Radke, Taylor J; Brown, Laura G; Faw, Brenda; Hedeen, Nicole; Matis, Bailey; Perez, Priscela; Viveiros, Brendalee; Ripley, Danny

2017-04-21

Food allergies affect an estimated 15 million persons in the United States (1), and are responsible for approximately 30,000 emergency department visits and 150-200 deaths each year (2). Nearly half of reported fatal food allergy reactions over a 13-year period were caused by food from a restaurant or other food service establishment (3). To ascertain the prevalence of food allergy training, training topics, and practices related to food allergies, CDC's Environmental Health Specialists Network (EHS-Net), a collaborative forum of federal agencies and state and local health departments with six sites, interviewed personnel at 278 restaurants. Fewer than half of the 277 restaurant managers (44.4%), 211 food workers (40.8%), and 156 servers (33.3%) interviewed reported receiving food allergy training. Among those who reported receiving training, topics commonly included the major food allergens and what to do if a customer has a food allergy. Although most restaurants had ingredient lists for at least some menu items, few had separate equipment or areas designated for the preparation of allergen-free food. Restaurants can reduce the risk for allergic reactions among patrons by providing food allergy training for personnel and ingredient lists for all menu items and by dedicating equipment and areas specifically for preparing allergen-free food.

The CACREP Site Visit Process

ERIC Educational Resources Information Center

Lee, Courtland C.

2013-01-01

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

Visiting Mom: A pilot evaluation of a prison-based visiting program serving incarcerated mothers and their minor children

PubMed Central

Schubert, Erin C.; Duininck, Megan; Shlafer, Rebecca J.

2016-01-01

We describe an evaluation of a prison visiting program, Extended Visiting (EV), for incarcerated mothers and their children. Mothers (N = 24) and caregivers (N = 19) were interviewed regarding experiences with the program. Mothers identified benefits including maintaining a relationship with children, physical contact, motivation, privacy, peer support, and personal growth. Caregivers echoed mothers’ appreciation for the opportunity to maintain mother-child relationships and physical contact. Mothers identified barriers including desire for overnight visits and more age-appropriate activities. Caregivers perceived travel time and costs and children’s adverse reactions as barriers. When comparing EV to typical visiting, participants unanimously preferred EV. PMID:27867281

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-14

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

Use of Dog Parks and the Contribution to Physical Activity for Their Owners.

PubMed

Evenson, Kelly R; Shay, Elizabeth; Williamson, Stephanie; Cohen, Deborah A

2016-06-01

This study described the use of dog parks in several diverse locations and explored the contribution dog parks made to physical activity of the dog owners. The Systematic Observation of Play and Recreation in Communities (SOPARC) tool was used to count the number and characteristics of people using parks. Observations were conducted 4 times per day, 4 days per week during for 1 week in 6 urban/suburban parks during different seasons. Collection sites included 3 dog parks in Chapel Hill/Durham, NC; 2 dog parks in Los Angeles, CA; and 1 dog park in Philadelphia, PA. Interviews at the NC and PA parks were conducted among 604 adults. We counted 2,124 people (11.9%) in the dog park area compared with 15,672 people in the remaining park areas. Based on observations, dog park visitors were more likely to be female and White or Other race/ethnicity compared with Hispanics, and were less likely to be children or engaged in walking or vigorous activity. Park interviews revealed that compared with other park activities, reporting walking/watching a dog at the park was more common among those who visited the park more frequently ( ≥ 1 time per week), stayed at the park for a shorter time ( ≤  1 hr), or visited the park alone. Although dog parks may be an important destination for dog owners and contribute to physical activity, the contribution of dog parks to participants' moderate-to-vigorous physical activity was limited.

Connectedness and citizenship: redefining social integration.

PubMed

Ware, Norma C; Hopper, Kim; Tugenberg, Toni; Dickey, Barbara; Fisher, Daniel

2007-04-01

Despite decades of deinstitutionalization, individuals with psychiatric disabilities living outside the hospital may be described as in the community, but not of it. To effectively address the persisting problem of social exclusion of persons with psychiatric disabilities, new conceptual tools are needed. To address this need, a new definition of social integration is offered. The definition is based on data from a qualitative study. Data collection consisted of individual, unstructured interviews with 56 adults who have been psychiatrically disabled (N=78 interviews) as well as ethnographic visits to five service sites working to promote social integration for their users (N=8 visits). An interpretive approach was used to analyze the data. Social integration is defined as a process, unfolding over time, through which individuals who have been psychiatrically disabled increasingly develop and exercise their capacities for connectedness and citizenship. Connectedness denotes the construction and successful maintenance of reciprocal interpersonal relationships. Social, moral, and emotional competencies are required to sustain connectedness. Citizenship refers to the rights and privileges enjoyed by members of a democratic society and to the responsibilities these rights engender. The definition calls for full rights and responsibilities of citizenship. The new definition sets an ideal, but not unrealistic, standard for social integration in the context of psychiatric disability. High standards encourage mental health professionals and policy makers to rethink what is possible for mental health services and to raise expectations for connectedness and citizenship among persons once disabled by mental illness.

Case management of patients with Type 2 diabetes mellitus: a cross-sectional survey in Chongqing, China.

PubMed

He, Miao; Gao, Jiaqi; Liu, Weiwei; Tang, Xiaojun; Tang, Shenglan; Long, Qian

2017-02-11

Type 2 diabetes mellitus has been identified as one of the priority diseases and included in the essential public health service package in China. This study investigated the frequency of follow-up visits and contents of care for case management of patients with Type 2 diabetes in Chongqing located in the western China, in terms of the regional practice guideline; and analyzed factors associated with the use of care. A cross-sectional survey was conducted with patients diagnosed with Type 2 diabetes in two areas in Chongqing. Total 502 participants (out of 664 people eligible) completed the interview. The outcome measures included at least four follow-up visits in a year, annual HbA1c test, blood lipid test and diabetic screening for nephropathy and eyes. Logistic regression analysis was applied to examine the association between participants' demographic and socio-economic characteristics and outcome measures. Over the one-year study period, 65% of participants had four or more follow-up visits. In light of the recommended tests, the proportions of having HbA1c test, blood lipid test and screening for nephropathy and eyes annually were 8, 54, 45 and 44%, respectively. After adjusting for study sites, age, sex, education, type of residence, level of income, the patients who were covered by Urban Employee Basic Medical Insurance, were enrolled in the targeted disease reimbursement program, and lived with diabetes more than five years were more likely to have regular follow-up visits and the recommended tests. Case management for patients with Type 2 diabetes mellitus was not effectively implemented in terms of frequency of follow-up visits and recommended tests over one-year period, as indicated in the regional practice guideline.

Obesity perceptions and documentation among primary care clinicians at a rural academic health center.

PubMed

Aleem, Sohaib; Lasky, Rosalind; Brooks, W Blair; Batsis, John A

2015-01-01

Obesity recognition in primary care is important to address the epidemic. We aimed to evaluate primary care clinician-reported documentation, management practices, beliefs and attitudes toward obesity compared to body mass index (BMI) calculation, obesity prevalence and actual documentation of obesity as an active problem in electronic health record in a rural academic center. Our target population for previously validated clinician survey was 56 primary care providers working at 3 sites. We used calendar year 2012 data for assessment of baseline system performance for metrics of documentation of BMI in primary care visits, and proportion of visits in patients with obesity with obesity as a problem. Standard statistical methods assessed the data. Survey response rate was 91%. Average age of respondents was 48.9 years and 62.7% were females. 72.5% clinicians reported having normal BMI. The majority of clinicians reported regularly documenting obesity as an active problem, and utilized motivational interviewing and basic good nutrition and healthy exercise. Clinicians identified lack of discipline and exercise time, access to unhealthy food and psychosocial issues as major barriers. Most denied disliking weight loss discussion or patients taking up too much time. In 21,945 clinic visits and 11,208 annual preventive care visits in calendar year 2012, BMI was calculated in 93% visits but obesity documentation as an active problem only 27% of patients meeting BMI criteria for obesity. Despite high clinician-reported documentation of obesity as an active problem, actual obesity documentation rates remained low in a rural academic medical center. Copyright © 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

What Do Recruiters Consider Important during the Employment Interview?

ERIC Educational Resources Information Center

Atkins, Carolyn P.; Kent, Robert L.

1988-01-01

Examined recruiters' attitudes regarding various hiring characteristics (communication, job selection, appearance) and their impact during initial campus interviews. Questionnaires were completed by 95 recruiters visiting West Virginia University and representing business/industry, hospitals/clinics, and public education. Results revealed that…

Evaluation of a peer assessment approach for enhancing the organizational capacity of state injury prevention programs.

PubMed

Hunter, Wanda M; Schmidt, Ellen R; Zakocs, Ronda

2005-01-01

To conduct a formative and pilot impact evaluation of the State Technical Assessment Team (STAT) program, a visitation-based (visitatie) peer assessment program designed to enhance the organizational capacity of state health department injury prevention programs. The formative evaluation was based on observational, record review, and key informant interview data collected during the implementation of the first 7 STAT visits. Pilot impact data were derived from semi-structured interviews with state injury prevention personnel one year after the visit. Formative evaluation identified 6 significant implementation problems in the first visits that were addressed by the program planners, resulting in improvements to the STAT assessment protocol. Impact evaluation revealed that after one year, the 7 state injury prevention programs had acted on 81% of the recommendations received during their STAT visits. All programs reported gains in visibility and credibility within the state health department and increased collaboration and cooperation with other units and agencies. Other significant program advancements were also reported. Specific program standards and review procedures are important to the success of peer assessment programs such as STAT. Early impact evaluation suggests that peer assessment protocols using the visitatie model can lead to gains in organizational capacity.

Intermediate Outcomes, Strategies, and Challenges of Eight Healthy Start Projects

PubMed Central

Walker, Deborah Klein; Hargreaves, Margaret; Rosenbach, Margo

2008-01-01

Site visits were conducted for the evaluation of the national Healthy Start program to gain an understanding of how projects design and implement five service components (outreach, case management, health education, depression screening and interconceptional care) and four system components (consortium, coordination/collaboration, local health system action plan and sustainability) as well as program staff’s perceptions of these components’ influence on intermediate outcomes. Interviews with project directors, case managers, local evaluators, clinicians, consortium members, outreach/lay workers and other stakeholders were conducted during 3-day in-depth site visits with eight Healthy Start grantees. Grantees reported that both services and systems components were related to self-reported service achievements (e.g. earlier entry into prenatal care) and systems achievements (e.g. consumer involvement). Outreach, case management, and health education were perceived as the service components that contributed most to their achievements while consortia was perceived as the most influential systems component in reaching their goals. Furthermore, cultural competence and community voice were overarching project components that addressed racial/ethnic disparities. Finally, there was great variability across sites regarding the challenges they faced, with poor service availability and limited funding the two most frequently reported. Service provision and systems development are both critical for successful Healthy Start projects to achieve intermediate program outcomes. Unique contextual and community issues influence Healthy Start project design, implementation and reported accomplishments. All eight projects implement the required program components yet outreach, case management, and health education are cited most frequently for contributing to their perceived achievements. PMID:19011959

Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project

PubMed Central

Stewart, Elizabeth E.; Nutting, Paul A.; Crabtree, Benjamin F.; Stange, Kurt C.; Miller, William L.; Jaén, Carlos Roberto

2010-01-01

PURPOSE We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes. METHODS An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site). RESULTS The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process. CONCLUSIONS The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning. PMID:20530392

Implementing the patient-centered medical home: observation and description of the national demonstration project.

PubMed

Stewart, Elizabeth E; Nutting, Paul A; Crabtree, Benjamin F; Stange, Kurt C; Miller, William L; Jaén, Carlos Roberto

2010-01-01

We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes. An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site). The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process. The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning.

The use of open source electronic health records within the federal safety net

PubMed Central

Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

2014-01-01

Objective To conduct a federally funded study that examines the acquisition, implementation and operation of open source electronic health records (EHR) within safety net medical settings, such as federally qualified health centers (FQHC). Methods and materials The study was conducted by the National Opinion Research Center (NORC) at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to West Virginia, California and Arizona FQHC that were currently using an open source EHR. Results Five of the six sites that were chosen as part of the study found a number of advantages in the use of their open source EHR system, such as utilizing a large community of users and developers to modify their EHR to fit the needs of their provider and patient communities, and lower acquisition and implementation costs as compared to a commercial system. Discussion Despite these advantages, many of the informants and site visit participants felt that widespread dissemination and use of open source was restrained due to a negative connotation regarding this type of software. In addition, a number of participants stated that there is a necessary level of technical acumen needed within the FQHC to make an open source EHR effective. Conclusions An open source EHR provides advantages for FQHC that have limited resources to acquire and implement an EHR, but additional study is needed to evaluate its overall effectiveness. PMID:23744787

Home health nurse decision-making regarding visit intensity planning for newly admitted patients: a qualitative descriptive study.

PubMed

Irani, Elliane; Hirschman, Karen B; Cacchione, Pamela Z; Bowles, Kathryn H

2018-04-13

Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency's protocols to develop the personalized visit plan. They revised the plan based on changes in the patient's clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients.

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

Treesearch

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

2002-01-01

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

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

Saturday Morning at the Jail: Implications of Incarceration for Families and Children.

ERIC Educational Resources Information Center

Arditti, Joyce A.; Lambert-Shute, Jennifer; Joest, Karen

2003-01-01

Using a conceptual framework that acknowledges the losses associated with a parent's incarceration, 56 caregivers visiting an incarcerated family member during children's visiting hours were interviewed. Problems believed to be created by incarceration included parenting strain, emotional stress, and concerns about children's loss of involvement…

Family Sense-Making Practices in Science Center Conversations

ERIC Educational Resources Information Center

Zimmerman, Heather Toomey; Reeve, Suzanne; Bell, Philip

2010-01-01

In this paper, we examine the interactional ways that families make meaning from biological exhibits during a visit to an interactive science center. To understand the museum visits from the perspectives of the families, we use ethnographic and discourse analytic methods, including pre- and postvisit interviews, videotaped observations of the…

Partnership Patterns: Addressing Emotional Needs in Early Intervention

ERIC Educational Resources Information Center

Brotherson, Mary Jane; Summers, Jean Ann; Naig, Lisa A.; Kyzar, Kathleen; Friend, Anna; Epley, Pamela; Gotto, George S., IV; Turnbull, Ann P.

2010-01-01

Home visiting in early intervention is the primary model for delivering services and building partnerships with children and families. Using interviews with early interventionists and family members, this study investigated the extent to which families' and professionals' emotional needs were met during home visits and what factors contributed to…

Visiting Shrines: A Turkish Religious Practice and Its Mental Health Implications

ERIC Educational Resources Information Center

Canel-Cinarbas, Deniz; Ciftci, Ayse; Bulgan, Gokce

2013-01-01

The purpose of the present study was to explore through qualitative methodology the practice of visiting shrines, a religious practice indigenous to Turkish Muslims, and its potential mental health benefits. Thirteen individuals were interviewed at two shrines in Istanbul, Turkey. The researchers focused on visitors' presenting issues, beliefs…

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

ERIC Educational Resources Information Center

Long, Jeffery D.

2018-01-01

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

An approach to improve the care of mid-life women through the implementation of a Women’s Health Assessment Tool/Clinical Decision Support toolkit

PubMed Central

Silvestrin, Terry M; Steenrod, Anna W; Coyne, Karin S; Gross, David E; Esinduy, Canan B; Kodsi, Angela B; Slifka, Gayle J; Abraham, Lucy; Araiza, Anna L; Bushmakin, Andrew G; Luo, Xuemei

2016-01-01

The objectives of this study are to describe the implementation process of the Women’s Health Assessment Tool/Clinical Decision Support toolkit and summarize patients’ and clinicians’ perceptions of the toolkit. The Women’s Health Assessment Tool/Clinical Decision Support toolkit was piloted at three clinical sites over a 4-month period in Washington State to evaluate health outcomes among mid-life women. The implementation involved a multistep process and engagement of multiple stakeholders over 18 months. Two-thirds of patients (n = 76/110) and clinicians (n = 8/12) participating in pilot completed feedback surveys; five clinicians participated in qualitative interviews. Most patients felt more prepared for their annual visit (69.7%) and that quality of care improved (68.4%) while clinicians reported streamlined patient visits and improved communication with patients. The Women’s Health Assessment Tool/Clinical Decision Support toolkit offers a unique approach to introduce and address some of the key health issues that affect mid-life women. PMID:27558508

Sensing kuuki among visiting nurses.

PubMed

Shimamura, Atsuko; Suwa, Sayuri; Tsujimura, Mayuko

2016-04-01

This study aimed to explore how visiting nurses in Japan sense Kuuki (mood or atmosphere) in the homes of patients and families. Participants were 15 Japanese visiting nurses with experience sensing kuuki in homes of patients and families. Data were collected through two 90 min focus group interviews with experienced visiting nurses, and a qualitative content analysis was performed. The qualitative analysis showed that experienced visiting nurses sensed kuuki in eight ways. Kuuki differs based on type of illness, state of health and number of visits. Sensitivity to kuuki is thought to be linked to understanding of patient and family feelings, changes in the physical condition of patients and evaluation of nursing care delivery. Perception of kuuki also contributes to care planning especially on the very first home visit and when visiting terminally ill patients. © 2016 Wiley Publishing Asia Pty Ltd.

[Scientific monitoring of the visitation procedure in inpatient rehabilitation centres of the German statutory pension insurance fund--the "Visit II" Project].

PubMed

Neuderth, S; Saupe-Heide, M; Brückner, U; Gross, B; Wenderoth, N; Vogel, H

2012-06-01

Visitation procedures are an established method of external quality assurance. They have been conducted for many years in the German statutory pension insurance's medical rehabilitation centres and have continuously been refined and standardized. The overall goal of the visitation procedure implemented by the German statutory pension fund is to ensure compliance with defined quality standards as well as information exchange and counselling of rehabilitation centres. In the context of advancing the visitation procedure in the German statutory pension funds' medical rehabilitation centres, the "Visit II" Project was initiated to evaluate the perspectives and expectations of the various professional groups involved in the visitations and to modify the materials used during visitations (documentation form and manual). Evaluation data from the rehabilitation centres visited in 2008 were gathered using both written surveys (utilization analysis) and telephone-based interviews with administration managers and chief physicians. The utilization analysis procedure was evaluated with regard to its methodological quality. In addition, the pension insurance physicians in charge of patient allocation during socio-medical assessment were surveyed with regard to potential needs for revision of the visitation procedure. Data collection was complemented by expert panels with auditors. Interviews with users as part of the formative evaluation of the visitation procedure showed positive results regarding acceptance and applicability of the visitations as well as of the utilization analysis procedures. Various suggestions were made with regard to modification and revision of the visitation materials, that could be implemented in many cases. Documentation forms were supplemented by current scientifically-based topics in rehabilitation (e. g., vocationally oriented measures), whereas items with minor relevance were skipped. The manual (for somatic indications) was thoroughly revised. The transparent presentation of visitation processes and visitation criteria has proven to be a useful basis for strengthening the cooperation between the statutory pension insurance funds and the rehabilitation centres. Moreover, it is a helpful tool for the systematic and continuous advancement of this complex method by including all parties involved. © Georg Thieme Verlag KG Stuttgart · New York.

Validation of the Telephone Interview of Cognitive Status and Telephone Montreal Cognitive Assessment Against Detailed Cognitive Testing and Clinical Diagnosis of Mild Cognitive Impairment After Stroke.

PubMed

Zietemann, Vera; Kopczak, Anna; Müller, Claudia; Wollenweber, Frank Arne; Dichgans, Martin

2017-11-01

Assessment of cognitive status poststroke is recommended by guidelines but follow-up can often not be done in person. The Telephone Interview of Cognitive Status (TICS) and the Telephone Montreal Cognitive Assessment (T-MoCA) are considered useful screening instruments. Yet, evidence to define optimal cut-offs for mild cognitive impairment (MCI) after stroke is limited. We studied 105 patients enrolled in the prospective DEDEMAS study (Determinants of Dementia After Stroke; NCT01334749). Follow-up visits at 6, 12, 36, and 60 months included comprehensive neuropsychological testing and the Clinical Dementia Rating scale, both of which served as reference standards. The original TICS and T-MoCA were obtained in 2 separate telephone interviews each separated from the personal visits by 1 week (1 before and 1 after the visit) with the order of interviews (TICS versus T-MoCA) alternating between subjects. Area under the receiver-operating characteristic curves was determined. Ninety-six patients completed both the face-to-face visits and the 2 interviews. Area under the receiver-operating characteristic curves ranged between 0.76 and 0.83 for TICS and between 0.73 and 0.94 for T-MoCA depending on MCI definition. For multidomain MCI defined by multiple-tests definition derived from comprehensive neuropsychological testing optimal sensitivities and specificities were achieved at cut-offs <36 (TICS) and <18 (T-MoCA). Validity was lower using single-test definition, and cut-offs were higher compared with multiple-test definitions. Using Clinical Dementia Rating as the reference, optimal cut-offs for MCI were <36 (TICS) and approximately 19 (T-MoCA). Both the TICS and T-MoCA are valid screening tools poststroke, particularly for multidomain MCI using multiple-test definition. © 2017 American Heart Association, Inc.

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

PubMed

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

2015-10-01

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

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

PubMed

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

2018-01-30

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

The effects of short interactive animation video information on preanesthetic anxiety, knowledge, and interview time: a randomized controlled trial.

PubMed

Kakinuma, Akihito; Nagatani, Hirokazu; Otake, Hiroshi; Mizuno, Ju; Nakata, Yoshinori

2011-06-01

We designed an interactive animated video that provides a basic explanation-including the risks, benefits, and alternatives-of anesthetic procedures. We hypothesized that this video would improve patient understanding of anesthesia, reduce anxiety, and shorten the interview time. Two hundred eleven patients scheduled for cancer surgery under general anesthesia or combined general and epidural anesthesia, who were admitted at least 1 day before the surgery, were randomly assigned to the video group (n = 106) or the no-video group (n = 105). The patients in the video group were asked to watch a short interactive animation video in the ward. After watching the video, the patients were visited by an anesthesiologist who performed a preanesthetic interview and routine risk assessment. The patients in the no-video group were also visited by an anesthesiologist, but were not asked to watch the video. In both groups, the patients were asked to complete the State-Trait Anxiety Inventory and a 14-point scale of knowledge test before the anesthesiologist's visit and on the day of surgery. We also measured interview time. There was no demographic difference between the 2 groups. The interview time was 34.4% shorter (video group, 12.2 ± 5.3 minutes, vs. no-video group, 18.6 ± 6.4 minutes; 95% confidence interval [CI] for the percentage reduction in time: 32.7%- 44.3%), and knowledge of anesthesia was 11.6% better in the video group (score 12.5 ± 1.4 vs. no-video group score 11.2 ± 1.7; 95% CI for the percentage increase in knowledge: 8.5%-13.9%). However, there was no difference in preanesthetic anxiety between the 2 groups. Our short interactive animation video helped patients' understanding of anesthesia and reduced anesthesiologists' interview time.

Characteristics of effective family medicine faculty development programs.

PubMed

Bland, C J; Stritter, F T

1988-01-01

Five federally funded family medicine faculty development programs were site visited from December 1985 to June 1986 to collect from experienced project directors, staff, and faculty their thoughts on training practices and future funding. The sites selected were the Faculty Development Center of Texas in Waco (McLennan County Medical Education and Research Foundation), the National Center for Faculty Development at the University of Miami, and programs at Michigan State University, the University of North Carolina-Chapel Hill, and Duke University. Since the late 1970s these programs have trained 259 fellows and 3,284 other participants. In total, $7,515,350 in federal dollars were spent. A variety of program formats and strategies were used to recruit faculty, and to prepare them in teaching, research, and other skill areas. Interviews (as well as phone conversations and letters) with key personnel at each site resulted in a summary of 30 critical elements identified for effective faculty development. Additionally, respondents made 11 specific recommendations to the Federal Faculty Development Grant Program that concern funding and future programs.

Knowledge-based systems in Japan

NASA Technical Reports Server (NTRS)

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

1994-01-01

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

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

ERIC Educational Resources Information Center

Burns, Adam

2017-01-01

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

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

PubMed

Jakobsson, Anna; Padrón, Benigno

2014-01-01

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

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

PubMed

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

2015-01-01

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

Backgrounds of women applying for hymen reconstruction, the effects of counselling on myths and misunderstandings about virginity, and the results of hymen reconstruction.

PubMed

van Moorst, Bianca R; van Lunsen, Rik H W; van Dijken, Dorenda K E; Salvatore, Concetta M

2012-04-01

ABSTRACT Objective To study the backgrounds of women requesting hymen 'repair', to assess the effects of extensive counselling, and the effects of hymen reconstruction. Methods A two-centre qualitative study, consisting of a semi-structured interview, education, discussion of alternatives, and instructions for self-examination (first visit), educational examination (second visit), decision on operation or alternative (third visit), and follow-up (fourth visit). Results Eighty-two women were interviewed at first visit. Sixty-eight women were followed until their decision to be operated upon or not. Forty-eight percent of all subjects reported a history of sexual violence, and 37% had had one or more abortions. Only 29% eventually decided to be operated. Seventeen of the 19 women who submitted to an operation and attended the follow-up visit reported no blood loss at first marital intercourse. Conclusions Most women requesting hymen reconstruction had a history complicated by critical life events related to their request. All women were afraid they would not bleed and/or would not be 'tight' enough during the wedding night. For 75% of the women empowerment by means of extensive counselling resulted in a decision against operation. Hymenoplasty alone does not help women because most operated women will not bleed and because they often also have to prove to be 'tight' enough.

Q & A with Ed Tech Leaders: Interview with Harold Stolovitch

ERIC Educational Resources Information Center

Shaughnessy, Michael F.

2016-01-01

Harold Stolovitch is Emeritus Professor of Workplace Learning & Performance, Université de Montréal, where he also served as Associate Dean of Research and Chair of the Instructional & Performance Technology graduate programs. He has also been a Distinguished Visiting Scholar and Visiting Professor at the University of Southern California.…

Native American Education Program, 1982-83. OEE Evaluation Report.

ERIC Educational Resources Information Center

Inman, Deborah

During 1982-83, the Native American Education Program provided after-school and summer session instruction and supportive services to approximately 450 Native American grade K-12 students scattered throughout New York City. Goals of visiting and interviewing 50% of the target population were realized, with 220 home visits made. Materials and…

Disability Awareness Activity

NASA Image and Video Library

2009-10-28

Maryland School for the Blind student Andrea Washington, left, in red, is interviewed by NASA television during a visit to NASA Headquarters in Washington, Thursday, Oct. 29, 2009. Seven students from the Maryland School for the Blind visited NASA and participated in activities to learn about NASA'smission, functions, and careers. Photo Credit: (NASA/Paul E. Alers)

Perspectives--Infant Mental Health Home Visiting Strategies: From the Parents' Points of View

ERIC Educational Resources Information Center

Weatherston, Deborah

2010-01-01

The author interviewed parents who had participated in infant mental health (IMH) home visiting programs in community mental health agencies in Detroit, Michigan, as part of a larger qualitative study exploring parents' and practitioners' perceptions of IMH practice. Parents were asked to describe what they remembered about the practitioner and…

Barriers to use of oral rehydration salts for child diarrhea in the private sector: evidence from India.

PubMed

Wagner, Zachary; Shah, Manan; Sood, Neeraj

2015-02-01

Diarrhea is the second leading cause of child mortality in India. Most deaths are cheaply preventable with the use of oral rehydration salts (ORS), yet many health providers still fail to provide ORS to children seeking diarrheal care. In this study, we use survey data to assess whether children visiting private providers for diarrheal care were less likely to use ORS than those visiting public providers. Results suggest that children who visited private providers were 9.5 percentage points less likely to have used ORS than those who visited public providers (95% CI 5-14). We complimented these results with in-depth interviews of 21 public and 17 private doctors in Gujarat, India, assessing potential drivers of public-private disparities in ORS use. Interview results suggested that lack of direct medication dispensing in the private sector might be a key barrier to ORS use in the private sector. © The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

PubMed

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

2000-03-01

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

Factors associated with the use of social workers for assistance with lifetime and 12-month behavioral health disorders.

PubMed

Woodward, Amanda Toler; Taylor, Robert Joseph

2018-04-01

This study examined the use of social workers for assistance with a behavioral health disorder. Data were from the Collaborative Psychiatric Epidemiology Surveys. The analytic sample included respondents who reported using professional services for assistance with a behavioral health disorder during their lifetime (n = 5,585). Logistic regression was used to examine the use of a social worker during the respondent's lifetime or 12 months prior to the interview. Ten percent of respondents visited a social worker for help with a behavioral health disorder during their lifetime and 3% did so in the 12 months prior to the interview. Women were less likely than men to report using a social worker. Those who visited a social worker tended to also use other professionals for a behavioral health disorder although overall respondents reported visiting social workers less frequently for this reason than other types of professionals.

Acción Mutua (Shared Action): a multipronged approach to delivering capacity-building assistance to agencies serving Latino communities in the United States.

PubMed

Ayala, George; Chión, Miguel; Díaz, Rafael M; Heckert, Andrea L; Nuño, Monica; del Pino, Homero E; Rodríguez, Claudia; Schroeder, Kurt; Smith, Terry

2007-01-01

Culturally appropriate, theory-based capacity-building assistance can serve a vital role in helping HIV prevention providers remain up-to-date, effective, and responsive to those they serve. Funded by the Centers for Disease Control and Prevention (CDC), AIDS Project Los Angeles, in collaboration with San Francisco State University's César E. Chávez Institute, conducted full-day site visits and qualitative interviews in 2005 with mid-level management staff of CDC-funded community-based organizations delivering HIV prevention services to Latino communities in the western region of the United States. We found that agencies we visited (1) had not yet adapted the evidence-based interventions they were using at the time of our visit and (2) requested technical assistance and training in the areas of program development, evaluation, group facilitation techniques, consumer recruitment, client retention, intervention adaptation, and materials development. Findings from this needs assessment were used to inform our seven-pronged approach to delivering capacity-building assistance entitled "Acción Mutua" (Shared Action). The approach emphasizes strategic partnerships, stakeholder involvement, organizational self-assessment, culturally appropriate materials development, interactive training, tailored onsite technical assistance, and professional networking opportunities. This article describes our approach in detail, the assessment process we used to develop it, and its implications for capacity-building practice.

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

ERIC Educational Resources Information Center

Minor, Amanda J.

2012-01-01

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

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

PubMed

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

2011-04-01

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

Electronic communication improves access, but barriers to its widespread adoption remain

PubMed Central

Bishop, Tara F.; Press, Matthew J.; Mendelsohn, Jayme L.; Casalino, Lawrence P.

2013-01-01

Principles of patient-centered care imply that physicians should use electronic communication with patients more extensively, including as a substitute for office visits when clinically appropriate. We interviewed leaders of 21 medical groups that use electronic communication with patients extensively and also interviewed staff in six of these groups. Electronic communication was widely perceived to be a safe, effective and efficient means of communication that improves patient satisfaction and saves patients time, but increases the volume of physician work unless office visits are reduced. Practice redesign and new payment methods are likely necessary for electronic communication to be used more extensively. PMID:23918479

The NASA Library and Researchers at Goddard: A Visitor's Perspective

ERIC Educational Resources Information Center

Powell, Jill H.

2014-01-01

Jill Powell, engineering librarian from Cornell University, visited the library at NASA Goddard in Greenbelt, Maryland in July 2013, interviewing library staff and selected NASA scientists. She studied the library's digital projects, publications, services, and operations. She also interviewed several NASA scientists on information-seeking…

Well-Child Care Redesign: A Mixed Methods Analysis of Parent Experiences in the PARENT Trial.

PubMed

Mimila, Naomi A; Chung, Paul J; Elliott, Marc N; Bethell, Christina D; Chacon, Sandra; Biely, Christopher; Contreras, Sandra; Chavis, Toni; Bruno, Yovana; Moss, Tanesha; Coker, Tumaini R

Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), is a well-child care (WCC) model that has demonstrated effectiveness in improving the receipt of comprehensive WCC services and reducing emergency department utilization for children aged 0 to 3 in low-income communities. PARENT relies on a health educator ("parent coach") to provide WCC services; it utilizes a Web-based previsit prioritization/screening tool (Well-Visit Planner) and an automated text message reminder/education service. We sought to assess intervention feasibility and acceptability among PARENT trial intervention participants. Intervention parents completed a survey after a 12-month study period; a 26% random sample of them were invited to participate in a qualitative interview. Interviews were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis; survey responses were analyzed using bivariate methods. A total of 115 intervention participants completed the 12-month survey; 30 completed a qualitative interview. Nearly all intervention participants reported meeting with the coach, found her helpful, and would recommend continuing coach-led well visits (97-99%). Parents built trusting relationships with the coach and viewed her as a distinct and important part of their WCC team. They reported that PARENT well visits more efficiently used in-clinic time and were comprehensive and family centered. Most used the Well-Visit Planner (87%), and found it easy to use (94%); a minority completed it at home before the visit (18%). Sixty-two percent reported using the text message service; most reported it as a helpful source of new information and a reinforcement of information discussed during visits. A parent coach-led intervention for WCC for young children is a model of WCC delivery that is both acceptable and feasible to parents in a low-income urban population. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Improved decision making in construction using virtual site visits.

DOT National Transportation Integrated Search

2003-01-01

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

Theory and data for simulating fine-scale human movement in an urban environment

PubMed Central

Perkins, T. Alex; Garcia, Andres J.; Paz-Soldán, Valerie A.; Stoddard, Steven T.; Reiner, Robert C.; Vazquez-Prokopec, Gonzalo; Bisanzio, Donal; Morrison, Amy C.; Halsey, Eric S.; Kochel, Tadeusz J.; Smith, David L.; Kitron, Uriel; Scott, Thomas W.; Tatem, Andrew J.

2014-01-01

Individual-based models of infectious disease transmission depend on accurate quantification of fine-scale patterns of human movement. Existing models of movement either pertain to overly coarse scales, simulate some aspects of movement but not others, or were designed specifically for populations in developed countries. Here, we propose a generalizable framework for simulating the locations that an individual visits, time allocation across those locations, and population-level variation therein. As a case study, we fit alternative models for each of five aspects of movement (number, distance from home and types of locations visited; frequency and duration of visits) to interview data from 157 residents of the city of Iquitos, Peru. Comparison of alternative models showed that location type and distance from home were significant determinants of the locations that individuals visited and how much time they spent there. We also found that for most locations, residents of two neighbourhoods displayed indistinguishable preferences for visiting locations at various distances, despite differing distributions of locations around those neighbourhoods. Finally, simulated patterns of time allocation matched the interview data in a number of ways, suggesting that our framework constitutes a sound basis for simulating fine-scale movement and for investigating factors that influence it. PMID:25142528

"They Told Me to Take Him Somewhere Else": Caregivers' Experiences Seeking Emergency Dental Care for Their Children.

PubMed

Meyer, Beau D; Lee, Jessica Y; Lampiris, Lewis N; Mihas, Paul; Vossers, Sarah; Divaris, Kimon

2017-05-15

The purpose of this mixed-methods study was to examine pediatric emergency dental trends in two safety net clinics and care-seeking experiences of young children's caregivers. Administrative data were used to describe and compare emergency first visits of children ages zero to six years in a community-based (CC) and a University-based (UC) safety net clinic from 2010 to 2014. In-person interviews were conducted with 11 caregivers of children ages zero to six presenting for nontrauma-related emergency visits at the UC from January to August 2016. Interviews were transcribed verbatim, coded, and analyzed inductively using Atlas. ti.7.5.9. The UC experienced significantly more emergency first visits (33 percent) than the CC (five percent, P<0.001), and the majority of these UC visits were referrals. Caregivers were dissatisfied with the experienced barriers of access to care and lack of child-centeredness, specifically the referral out of the dental home for emergency dental care. A considerable proportion of children's first visits at dental safety net clinics was emergency related. Children's caregivers voiced issues related to access to care and lack of child-centered care. Discordance was apparent between how professional organizations define the dental home and how caregivers experience it in the context of emergency care.

Multi-hierarchical movements in self-avoiding walks

NASA Astrophysics Data System (ADS)

Sakiyama, Tomoko; Gunji, Yukio-Pegio

2017-07-01

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

Primary care patients’ expectations regarding medical appointments and their experiences during a visit: does age matter?

PubMed Central

Jaworski, Mariusz; Rzadkiewicz, Marta; Adamus, Miroslawa; Chylinska, Joanna; Lazarewicz, Magdalena; Haugan, Gørill; Lillefjell, Monica; Espnes, Geir Arild; Wlodarczyk, Dorota

2017-01-01

Introduction There is evidence that meeting patients’ expectations toward health care correlates with involvement in the treatment they receive. The most important patient expectations concern certain types of information: explanation of disease and treatment, health promotion, and improvement in quality of life. Other demands include proper rapport and emotional support. The aim of this paper was to examine different patient groups over the age of 50 years and their expectations toward medical visits, evaluated before a visit and after the visit. Patients and methods The study group consisted of 4,921 primary health-care patients. The patients received self-administered questionnaires that they filled in before and after the appointment with the doctor. Interviews with patients were conducted individually by specially trained interviewers. The PRACTA Patient Expectations Scale was used to measure the appointment-related expectations of the patients. Results We observed differences related to age in patients’ expectations before medical visits regarding the following factors: disease explanation, treatment explanation, quality of life, rapport, and emotional support. The same differences were not observed on health promotion. Evaluation of patients’ appointment-related experiences after the visit showed that there were significant differences between the age-groups regarding all types of expectations included in the study. Differences between previsit and postvisit measurements were statistically significant in all age-groups. Patients who received less than they expected from doctors outnumbered those who received what they expected or more in all the groups. Conclusion Patients’ expectations toward medical visits are conditioned by age. Therefore, doctors should pay more attention to requirements related to age in their effort to identify and satisfy expectations. This is particularly important in light of the discrepancy between previsit expectations and the actual experiences of patients evaluated after the visit. PMID:28761335

Primary care patients' expectations regarding medical appointments and their experiences during a visit: does age matter?

PubMed

Jaworski, Mariusz; Rzadkiewicz, Marta; Adamus, Miroslawa; Chylinska, Joanna; Lazarewicz, Magdalena; Haugan, Gørill; Lillefjell, Monica; Espnes, Geir Arild; Wlodarczyk, Dorota

2017-01-01

There is evidence that meeting patients' expectations toward health care correlates with involvement in the treatment they receive. The most important patient expectations concern certain types of information: explanation of disease and treatment, health promotion, and improvement in quality of life. Other demands include proper rapport and emotional support. The aim of this paper was to examine different patient groups over the age of 50 years and their expectations toward medical visits, evaluated before a visit and after the visit. The study group consisted of 4,921 primary health-care patients. The patients received self-administered questionnaires that they filled in before and after the appointment with the doctor. Interviews with patients were conducted individually by specially trained interviewers. The PRACTA Patient Expectations Scale was used to measure the appointment-related expectations of the patients. We observed differences related to age in patients' expectations before medical visits regarding the following factors: disease explanation, treatment explanation, quality of life, rapport, and emotional support. The same differences were not observed on health promotion. Evaluation of patients' appointment-related experiences after the visit showed that there were significant differences between the age-groups regarding all types of expectations included in the study. Differences between previsit and postvisit measurements were statistically significant in all age-groups. Patients who received less than they expected from doctors outnumbered those who received what they expected or more in all the groups. Patients' expectations toward medical visits are conditioned by age. Therefore, doctors should pay more attention to requirements related to age in their effort to identify and satisfy expectations. This is particularly important in light of the discrepancy between previsit expectations and the actual experiences of patients evaluated after the visit.

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

PubMed Central

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

2013-01-01

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

Informed Strangers: Witnessing and Responding to Unethical Care as Student Nurses.

PubMed

Engel, Joyce; Salfi, Jenn; Micsinszki, Samantha; Bodnar, Andrea

2017-01-01

Nursing students occupy a unique perspective in clinical settings because they are informed, through education, about how patient care ought to happen. Given the brevity of placements and their "visiting status" in clinical sites, students are less invested in the ethos of specific sites. Subsequently, their perspectives of quality care are informed by what should happen, which might differ from that of nurses and patients. The purpose of this study was to identify predominant themes in patient care, as experienced by students, and the influence that these observations have on the development of their ethical reasoning. Using a qualitative descriptive approach in which 27 nursing student papers and three follow-up in-depth interviews were analyzed, three main themes emerged: Good employee, poor nurse; damaged care; and negotiating the gap. The analysis of the ethical situations in these papers suggests that students sometimes observe care that lacks concern for the dignity, autonomy, and safety of patients. For these student nurses, this tension led to uncertainty about patient care and their eventual profession.

Using the emergency department as a screening site for high blood pressure. A method for improving hypertension detection and appropriate referral.

PubMed

Mamon, J; Green, L; Levine, D M; Gibson, G; Gurley, H T

1987-08-01

This study describes the development and testing of a high blood pressure protocol for use in emergency departments (ED) to enhance detection of those patients appropriate for subsequent referral. The protocol involves two serial blood pressure measurements and a patient interview to determine: 1) previous history of high blood pressure (HBP), 2) treatment in past year for HBP, and 3) usual source of medical care. The accuracy of patient reporting was validated by comparison with the patients' hospital record (reflecting outpatient and inpatient visits). Results indicate that these self-reports have high levels of sensitivity (range 90-100%) and specificity (range 79-96%). Use of the additional patient information increased the sensitivity of the screening protocol in identifying when and where a patient should be referred. Use of this methodology indicates that the protocol is a simple and effective method for HBP screening. The findings also suggest that the ED is an ideal site for screening the "hard-to-reach" hypertensive population.

A multisite study of implementing supported employment in the Netherlands.

PubMed

van Erp, Nicole H J; Giesen, Femke B M; van Weeghel, Jaap; Kroon, Hans; Michon, Harry W C; Becker, Deborah; McHugo, Gregory J; Drake, Robert E

2007-11-01

This article reports on the implementation of the individual placement and support model of supported employment in four Dutch regions. The authors used structured site visits, employment data, and semistructured interviews to assess fidelity, employment outcomes, and facilitators of and barriers to successful implementation. At 24 months, the four sites reached a mean+/-SD fidelity score of 4.1+/-.3 (possible scores range from 1 to 5, with higher scores indicating closer adherence to the model). Of the 316 persons with mental illnesses, 57 (18%) obtained competitive jobs. Barriers to implementation included lack of organizational standards, loss of vocational staff, funding problems, insufficient time for program leaders, and inadequate cooperation between the involved organizations. Important facilitators were the skills and commitment of the vocational team members and the integration of vocational and mental health staff. To implement evidence-based supported employment in the Netherlands will require changes in financing, organizational structures, attitudes, cultural beliefs, and labor and disability regulations.

From Schoolhouse to Statehouse: Community Organizing for Public School Reform.

ERIC Educational Resources Information Center

Kamber, Thomas

This report reviews the activities, strategies, successes, and problems of diverse school reform efforts across a 14-state sample of community organizations. In 1999 and 2000, interviewers visited over 40 organizations and conducted telephone interviews with dozens of other organizations involved in education reform. They met with directors,…

Mesopredator behavioral response to olfactory signals of an apex predator.

PubMed

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

2017-01-01

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

Parents' Perspectives: An Evaluation of Case Management Interventions in Home Visiting Programs for Young Children

ERIC Educational Resources Information Center

Allen, Susan F.

2007-01-01

In home visiting programs for children younger than age three, home visitors work with parents to enhance the child's environment. This study examined how the home visitor-parent relationship, amount of contact, and level of need affected the intensity of case management interventions received. Researchers interviewed 90 mothers to measure the…

Weaving Emotional Intelligence into a Home Visiting Model

ERIC Educational Resources Information Center

Enson, Beth; Imberger, Jaci

2017-01-01

This article details the impact of Emotional Intelligence (EI) training on the 10-year evolution of the Taos First Steps Home Visiting program. While EI has become standard fare in corporate training and practice, it is less well known in the world of early childhood services. This article highlights interviews with key personnel, both in-house…

Selectively willing and conditionally able: HIV vaccine trial participation among women at "high risk" of HIV infection.

PubMed

Voytek, Chelsea D; Jones, Kevin T; Metzger, David S

2011-08-18

Efficacy studies of investigational HIV vaccines require enrollment of individuals at 'high risk' for HIV. This paper examines participation in HIV vaccine trials among women at 'high risk' for HIV acquisition. In-depth interviews were conducted with 17 African-American women who use crack cocaine and/or exchange sex for money/drugs to elicit attitudes toward medical research and motivators and deterrents to HIV vaccine trial participation. Interviews were digitally recorded and transcribed; data were coded and compiled into themes. Most women expressed favorable attitudes toward medical research in general. Motivators for trial participation included compensation; personal benefits including information, social services, and the possibility that the trial vaccine could prevent HIV; and altruism. Deterrents included: dislike of needles; distrust; concern about future consequences of participating. In addition, contingencies, care-giving responsibilities, and convenience issues constituted barriers which could impede participation. Respondents described varied, complex perspectives, and individual cases illustrate how these themes played out as women contemplated trial participation. Understanding factors which influence vaccine research participation among women at 'high risk' can aid sites to tailor recruitment procedures to local contexts. Concerns about future reactions can be addressed through sustained community education. Convenience barriers can be ameliorated by providing rides to study visits when necessary, and/or conducting study visits in accessible neighborhood locations. Women in this sample thought carefully about enrolling in HIV vaccine trials given the structural constraints within which they lived. Further research is needed regarding structural factors which influence personal agency and individuals' thinking about research participation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Pediatric provider processes for behavioral health screening, decision making, and referral in sites with colocated mental health services.

PubMed

Hacker, Karen; Goldstein, Joel; Link, David; Sengupta, Nandini; Bowers, Rachael; Tendulkar, Shalini; Wissow, Larry

2013-01-01

Validated behavioral health (BH) screens are recommended for use at well-child visits. This study aimed to explore how pediatricians experience and use these screens for subsequent care decisions in primary care. The study took place at 4 safety net health centers. Fourteen interviews were conducted with pediatricians who were mandated to use validated BH screens at well-child visits. Interview questions focused on key domains, including clinic BH context, screening processes, assessment of screening scores, and decision making about referral to mental health services. Qualitative analysis used the Framework Approach. A variety of themes emerged: BH screens were well accepted and valued for the way they facilitated discussion of mental health issues. However, screening results were not always used in the way that instrument designers intended. Providers' beliefs about the face validity of the instruments, and their observations about performance of instruments, led to discounting scored results. As a result, clinical decisions were made based on a variety of evidence, including individual item responses, parent or patient concerns, and perceived readiness for treatment. Additionally, providers, although interested in expanding their mental health discussions, perceived a lack of time and of their own skills to be major obstacles in this pursuit. Screens act as important prompts to stimulate discussion of BH problems, but their actual scored results play a variable role in problem identification and treatment decisions. Modifications to scheduling policies, additional provider training, and enhanced collaboration with mental health professionals could support better BH integration in pediatric primary care.

Randomized trial of a statewide home visiting program: impact in preventing child abuse and neglect.

PubMed

Duggan, Anne; McFarlane, Elizabeth; Fuddy, Loretta; Burrell, Lori; Higman, Susan M; Windham, Amy; Sia, Calvin

2004-06-01

To assess the impact of home visiting in preventing child abuse and neglect in the first 3 years of life in families identified as at-risk of child abuse through population-based screening at the child's birth. This experimental study focused on Hawaii Healthy Start Program (HSP) sites operated by three community-based agencies. From 11/94 to 12/95, 643 families were enrolled and randomly assigned to intervention and control groups. Child abuse and neglect were measured by observed and self-reported parenting behaviors, all hospitalizations for trauma and for conditions where hospitalization might have been avoided with adequate preventive care, maternal relinquishment of her role as primary caregiver, and substantiated CPS reports. Data were collected through annual maternal interviews (88% follow-up each year of all families with baseline interviews); observation of the home environment; and review of CPS, HSP, and pediatric medical records. HSP records rarely noted home visitor concern about possible abuse. The HSP and control groups were similar on most measures of maltreatment. HSP group mothers were less likely to use common corporal/verbal punishment (AOR=.59, p=.01) but this was attributable to one agency's reduction in threatening to spank the child. HSP group mothers reported less neglectful behavior (AOR=.72, .02), related to a trend toward decreased maternal preoccupation with problems and to improved access to medical care for intervention families at one agency. The program did not prevent child abuse or promote use of nonviolent discipline; it had a modest impact in preventing neglect. Possible targets for improved effectiveness include the program's implementation system and model.

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

EPA Pesticide Factsheets

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

76 FR 4919 - Regulatory Site Visit Training Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-27

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

75 FR 6404 - Regulatory Site Visit Training Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-09

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

Health Care Merged With Senior Housing: Description and Evaluation of a Successful Program.

PubMed

Barry, Theresa Teta

2017-01-01

Objective: This article describes and evaluates a successful partnership between a large health care organization and housing for seniors. The program provides on-site, primary care visits by a physician and a nurse in addition to intensive social services to residents in an affordable senior housing apartment building located in Pennsylvania. Per Donabedian's "Structure-Process-Outcome" model, the program demonstrated positive health care outcomes for its participants via a prescribed structure. To provide guidance for replication in similar settings, we qualitatively evaluated the processes by which successful outcomes were obtained. Methods: With program structures in place and outcomes measured, this case study collected and analyzed qualitative information taken from key informant interviews on care processes involved in the program. Themes were extracted from semistructured interviews and used to describe the processes that helped and hindered the program. Results and Discussion: Common processes were identified across respondents; however, the nuanced processes that lead to successful outcomes suggest that defined structures and processes may not be sufficient to produce similar outcomes in other settings. Further research is needed to determine the program's replicability and policy implications.

Information, Motivation, and Behavioral Skills of High-risk Young Adults to Use the HIV Self-Test

PubMed Central

Brown, William; Carballo-Diéguez, Alex; John, Rita Marie; Schnall, Rebecca

2016-01-01

HIV Self Tests (HIVST) have the potential to increase testing among young adults. However, little is known about high-risk young adults‘ perception of the HIVST as a risk reduction tool and how they would use the HIVST in their everyday lives. Our study sought to examine these factors. Twenty-one ethnically diverse participants (ages 18–24) used the HIVST at our study site, completed surveys, and underwent an in-depth interview. Descriptive statistics were used to analyze the survey responses, and interview data were coded using constructs from the Information-Motivation-Behavioral skills model. Information deficits included: how to use the HIVST and the “window period” for sero-conversion. Motivations supporting HIVST use included: not needing to visit the clinic, fast results, easy access, and use in non-monogamous relationships. Behavioral skills discussed included: coping with a positive test, handling partner violence after a positive test, and accessing HIV services. These findings can inform the use of the HIVST for improving HIV testing rates and reducing HIV risk behavior. PMID:26885813

Examining the validity of AHRQ's patient safety indicators (PSIs): is variation in PSI composite score related to hospital organizational factors?

PubMed

Shin, Marlena H; Sullivan, Jennifer L; Rosen, Amy K; Solomon, Jeffrey L; Dunn, Edward J; Shimada, Stephanie L; Hayes, Jennifer; Rivard, Peter E

2014-12-01

Increasing use of Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) for hospital performance measurement intensifies the need to critically assess their validity. Our study examined the extent to which variation in PSI composite score is related to differences in hospital organizational structures or processes (i.e., criterion validity). In site visits to three Veterans Health Administration hospitals with high and three with low PSI composite scores ("low performers" and "high performers," respectively), we interviewed a cross-section of hospital staff. We then coded interview transcripts for evidence in 13 safety-related domains and assessed variation across high and low performers. Evidence of leadership and coordination of work/communication (organizational process domains) was predominantly favorable for high performers only. Evidence in the other domains was either mixed, or there were insufficient data to rate the domains. While we found some evidence of criterion validity, the extent to which variation in PSI rates is related to differences in hospitals' organizational structures/processes needs further study. © The Author(s) 2014.

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

PubMed

Roubik, D W; Ackerman, J D

1987-09-01

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

Site visits to initiate recruitment in a clinical trial: does it matter who conducts the visit? Protocol for implementation in trials.

PubMed

Nollett, Claire; Kelson, Mark; Hood, Kerenza

2016-11-01

The Study Within a Trial (SWAT) program exists to 'embed research within research, so as to resolve uncertainties about the different ways of designing, conducting, analyzing, and interpreting evaluations of health and social care' (1). Published in this journal in 2013, a template for the first SWAT protocol outlined an investigation into the effects of site visits by the principal investigator on recruitment in multicentre randomized controlled trials (1). We have now designed a SWAT protocol to extend this question and ask 'does it matter who conducts the site visit?' Our aim is to provide a protocol that trials can implement to address this research question. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

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

EPA Pesticide Factsheets

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

Supporting Faculty Learning About Teaching: The On the Cutting Edge Website

NASA Astrophysics Data System (ADS)

Fox, S.; Iverson, E. A.; Manduca, C. A.; Kirk, K. B.; McDaris, J. R.; Ormand, C. J.; Bruckner, M. Z.

2011-12-01

The On the Cutting Edge website captures information about teaching geoscience from workshop participants and leaders. Designed to both support workshop participants in making use of ideas developed at the workshop and to allow a broader audience to access these ideas, the site includes more than 4900 pages of content in 39 topical collections with more than 1400 community-contributed teaching activities. The site is well used: in 2010, 850,000 visitors made more than one million visits to the site viewing more than 2.1 million pages. To obtain a more detailed understanding of site use within our target population, we interviewed a sample of 30 geoscience faculty. Five primary uses were described repeatedly and in depth: finding ideas for teaching, understanding what colleagues are doing in specific teaching situations, learning about methods, tools, or topic in education or geoscience, finding visualizations, and networking or career planning. Interviewees could describe particular instances where they made use of teaching materials and could cite reasons why they believed this improved student learning. To understand how these uses are manifest in the weblogs, a sample of 73 sessions that lasted at least 10 minutes, and viewed 10 or more pages were selected from March 2009 logs. Sessions were selected to sample heavy use of one or more topical collections, and to sample the diversity of log characteristics. The sessions were described qualitatively and the resulting descriptions categorized. Four recognizable use patterns emerged: activity browsing in some cases combined with study of a pedagogic method, browsing visualizations and associated topical content, digging deep within a particular topical collection, and cross-site browsing. These patterns seem consistent with the uses reported in the interviews. An analysis of characteristics of all sessions in 2008 viewing 10 or more pages indicate that the major uses described in the interview study by 30 faculty are in fact widespread among the 16,000 users seeing 10 or more pages. The most widespread identifiable use is finding teaching activities or finding out what colleagues are doing in a particular teaching situation (20-40% of use). Roughly 30% of use appears to be related to seeking visualizations for class. Another 20% of use includes learning about pedagogic methods, though that may not be the users' intention when they enter the site. As in the interview study, use associated with finding career information is significant though less common (10% of use). The relative distribution of page views across modules is well aligned with the reported uses, and offers further confirmation that these uses are widely represented in the deep sessions.

"Purely for You": Inmates' Perceptions of Prison Visitation by Volunteers in the Netherlands.

PubMed

Schuhmann, Carmen; Kuis, Esther; Goossensen, Anne

2018-03-01

Research suggests that prison visitation by volunteers may significantly reduce the risk of recidivism. Community volunteers offer sustained, prosocial support to inmates which may account for these beneficial effects. However, the question of how inmates themselves evaluate volunteer visitation has hardly been studied. This study explores how inmates of Dutch prisons who receive one-on-one volunteer visits experience and value these visits. To that end, semistructured interviews were conducted with 21 inmates across six penitentiaries. These show that the value of volunteer visitation for inmates has to be understood in terms of a human-to-human encounter. Visits by volunteers provide inmates with rare opportunities to have a confidential conversation, away from the harshness of the usual prison life. Furthermore, inmates perceive volunteer visitation as beneficial beyond the actual visits. Inmates draw hope, strength, or self-respect from the conversations; they see volunteers as role models and develop a more positive view of the future. Two potential obstacles to beneficial volunteer visitation were detected: lack of chemistry between volunteer and inmate and imposition of worldview beliefs by volunteers.

What Do We Do Today, Daddy? (Father's Perception of His Role and Responsibilities).

ERIC Educational Resources Information Center

Woolner, Rosestelle B.

This paper presents brief summaries of two exploratory studies conducted to determine the non-custodial father's perception of his role and responsibilities following divorce. In Study I, eight middle class males who visited their children at least twice a month were interviewed individually. The interview consisted of a structured questionnaire…

Acculturation Strategy, Integration Paradoxes and Educational Adaptation--A Case Study of Chinese Visiting Scholar's Family in the United States

ERIC Educational Resources Information Center

Weidong, Li; Chen, Sisi

2017-01-01

In this case study, we developed a theoretical framework for examining the relationship between acculturation strategy and educational adaptation. By interviews and observations of one Chinese visiting scholar's family in the United States, we found that the family utilized "integration" as the acculturation strategy to adapt to the US…

Getting to "Yes": Closing the Enrollment Interview with Comfort and Confidence

ERIC Educational Resources Information Center

Wassom, Julie

2004-01-01

Closing is one of the most neglected or mistreated techniques in enrollment building. Yet those directors who close well consistently convert more calls to visits and visits to enrollments than those who educate their prospects well, but who do not ASK them to take action. A good closing question asks the prospect for a decision that is based upon…

A Classroom of One: How Online Learning Is Changing Our Schools and Colleges.

ERIC Educational Resources Information Center

Maeroff, Gene I.

The principles and practice of online learning in schools and classrooms were examined. The data sources used for the study were as follows: face-to-face and telephone interviews; several field visits; a review of the literature; online visits to courses, chat rooms, and threaded discussions; and e-mail exchanges. The future of online learning at…

'Sticking to carpets' - assessment and judgement in health visiting practice in an era of risk: a qualitative study.

PubMed

King, Caroline

2016-07-01

This paper aims to explore health visitors' accounts of assessment and judgement in health visiting in the context of policy change and an increased focus on risk, which is reshaping practice. Assessment and judgement underpin the targeting of support in health visiting practice. Existing literature suggests that needs assessment in health visiting is a complex process which draws on different types of knowledge. The study, upon which this paper draws, was a qualitative exploration which aimed to explore the impact of policy change on health visiting practice and on families. The accounts of sixteen health visitors, who took part in semi-structured interviews, are reported. The interview data were analysed using thematic and narrative techniques. Health visitors' accounts of their observations of families' homes, relationships and practices, such as their references to 'dirt', harmful practices and appropriateness, illustrate ways in which assessment and judgement in health visiting practice are shaped by a discourse of risk and notions of ideal parenting. Health visitors problematise this discourse in relation to the potential stigmatising impacts for families. Although health visitors indicate ambivalence towards the use of assessment tools, the findings indicate that they feel the tools provide them with a safety-net at a time when their practice is being reshaped by a discourse of risk. This paper identifies that assessment and judgement in contemporary health visiting are shaped by a discourse of risk. A discussion of the role of 'emotion in use' and collective emotions provides an appropriate theoretical lens to consider the impact that risk discourse has on health visiting practice and on families. This study highlights the need for assessment and judgement in health visiting practice to be highly reflexive, to support families in an era of risk. © 2016 John Wiley & Sons Ltd.

Caries experience of adults attending private and public dental clinics in Australia.

PubMed

Brennan, David S; Do, Loc Giang; Slade, Gary D

2011-01-01

In Australia, the majority of dental patients attend the private sector, while those with means tested eligibility for government assistance may attend the public sector. The aims of this study were to compare dental caries among persons who last visited private and public clinics, controlling for age, sex, reason for visit, and income. Data were collected in 2004-06, using a three-stage, stratified clustered sample of Australians aged 15+years, involving a computer-assisted telephone interview (CATI), oral examination, and mailed questionnaire. A total of 14,123 adults responded to the CATI (49 percent response) of whom 5,505 (44 percent of those interviewed) had an oral epidemiological examination. Multivariate regression analysis controlling for age, sex, reason for visit, and showed (P < 0.05) that persons attending public clinics had higher levels of decayed (beta = 0.33) and missing teeth (beta = 0.83), but lower levels of filled teeth (beta = -1.09) compared with the reference category of private clinics. Persons who attend for dental care in the public sector have worse oral health than adults who visit private dental clinics, in addition to an independent effect of socioeconomic disadvantage.

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

PubMed

Choi, Chang Won; Park, Moon Sung

2015-10-01

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

How economic contexts shape calculations of yield in biodiversity offsetting.

PubMed

Carver, L; Sullivan, S

2017-10-01

We examined and analyzed methods used to create numerical equivalence between sites affected by development and proposed conservation offset sites. Application of biodiversity offsetting metrics in development impact and mitigation assessments is thought to standardize biodiversity conservation outcomes, sometimes termed yield by those conducting these calculations. The youth of biodiversity offsetting in application, however, means little is known about how biodiversity valuations and offset contracts between development and offset sites are agreed on in practice or about long-term conservation outcomes. We examined how sites were made commensurable and how biodiversity gains or yields were calculated and negotiated for a specific offset contract in a government-led pilot study of biodiversity offsets in England. Over 24 months, we conducted participant observations of various stages in the negotiation of offset contracts through repeated visits to 3 (anonymized) biodiversity offset contract sites. We conducted 50 semistructured interviews of stakeholders in regional and local government, the private sector, and civil society. We used a qualitative data analysis software program (DEDOOSE) to textually analyze interview transcriptions. We also compared successive iterations of biodiversity-offsetting calculation spreadsheets and planning documents. A particular focus was the different iterations of a specific biodiversity impact assessment in which the biodiversity offsetting metric developed by the U.K.'s Department for Environment, Food and Rural Affairs was used. We highlight 3 main findings. First, biodiversity offsetting metrics were amended in creative ways as users adapted inputs to metric calculations to balance and negotiate conflicting requirements. Second, the practice of making different habitats equivalent to each other through the application of biodiversity offsetting metrics resulted in commensuration outcomes that may not provide projected conservation gains. Third, the pressure of creating value for money diminished projected conservation yields. © 2017 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

CyberHunt: Head Off to Antarctica.

ERIC Educational Resources Information Center

Kloza, Brad

2001-01-01

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-16

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

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

EPA Pesticide Factsheets

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

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

USDA-ARS?s Scientific Manuscript database

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

Convergence. Final Report

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

Needham, C.; McPherson, K.

2004-03-10

We contacted 125 scientists, ethicists, legal scholars, social scientists and informal science educators to participate in a short survey designed to identify critical issues related to nanotechnology. Fifty-six (45%) responded positively, and 46 completed the survey. We then conducted a series of interviews and site visits based on scientific area, and regional representation. Key points are summarized in the attached table. Based on the results of our surveys, we were able to construct three strong areas of ethical, legal, social, and environmental issues around which to build socratic dialogs in a standard Fred Friendly Seminar format. We were also ablemore » to identify 4 science center/museum partnerships and a proposal has been submitted to NSF's NISE Program. We are preparing to submit proposals to other agencies and foundations for support.« less

Financial viability, medical technology, and hospital closures.

PubMed

Prince, T R; Sullivan, J A

2000-01-01

Informed investments in medical technology and information systems are associated with the financial viability of community hospitals. Financially distressed facilities are 3 to 4 years behind proactive hospitals in supporting high-speed data, voice, and image transmissions to physicians in various locations. Impact of the Balanced Budget Act of 1997, fraud and abuse activities, Y2K issues, and lack of information systems support for physicians will result in 800 hospital closures and mergers of distressed hospitals over the next 60 months. These findings are based on the application of an eight-step framework for classifying information systems in health care entities. This framework is validated by survey instruments, site visits, interviews with senior management in 44 health care entities containing 576 hospitals, and judgments on the financial status of the health care entities.

Patient-Provider Concordance with Behavioral Change Goals Drives Measures of Motivational Interviewing Consistency

PubMed Central

Laws, M. Barton; Rose, Gary S.; Beach, Mary Catherine; Lee, Yoojin; Rogers, William S.; Velasco, Alyssa Bianca; Wilson, Ira B.

2015-01-01

Objective Motivational Interviewing (MI) consistent talk by a counselor is thought to produce “change talk” in clients. However, it is possible that client resistance to behavior change can produce MI inconsistent counselor behavior. Methods We applied a coding scheme which identifies all of the behavioral counseling about a given issue during a visit (“episodes”), assesses patient concordance with the behavioral goal, and labels providers’ counseling style as facilitative or directive, to a corpus of routine outpatient visits by people with HIV. Using a different data set of comparable encounters, we applied the concepts of episode and concordance, and coded using the Motivational Interviewing Treatment Integrity system. Results Patient concordance/discordance was not observed to change during any episode. Provider directiveness was strongly associated with patient discordance in the first study, and MI inconsistency was strongly associated with discordance in the second. Conclusion Observations that MI-consistent behavior by medical providers is associated with patient change talk or outcomes should be evaluated cautiously, as patient resistance may provoke MI-inconsistency. Practice Implications Counseling episodes in routine medical visits are typically too brief for client talk to evolve toward change. Providers with limited training may have particular difficulty maintaining MI consistency with resistant clients. PMID:25791372

Patient-provider concordance with behavioral change goals drives measures of motivational interviewing consistency.

PubMed

Laws, Michael Barton; Rose, Gary S; Beach, Mary Catherine; Lee, Yoojin; Rogers, William S; Velasco, Alyssa Bianca; Wilson, Ira B

2015-06-01

Motivational Interviewing (MI) consistent talk by a counselor is thought to produce "change talk" in clients. However, it is possible that client resistance to behavior change can produce MI inconsistent counselor behavior. We applied a coding scheme which identifies all of the behavioral counseling about a given issue during a visit ("episodes"), assesses patient concordance with the behavioral goal, and labels providers' counseling style as facilitative or directive, to a corpus of routine outpatient visits by people with HIV. Using a different data set of comparable encounters, we applied the concepts of episode and concordance, and coded using the Motivational Interviewing Treatment Integrity system. Patient concordance/discordance was not observed to change during any episode. Provider directiveness was strongly associated with patient discordance in the first study, and MI inconsistency was strongly associated with discordance in the second. Observations that MI-consistent behavior by medical providers is associated with patient change talk or outcomes should be evaluated cautiously, as patient resistance may provoke MI-inconsistency. Counseling episodes in routine medical visits are typically too brief for client talk to evolve toward change. Providers with limited training may have particular difficulty maintaining MI consistency with resistant clients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Early incidence of occupational asthma is not accelerated by atopy in the bakery/pastry and hairdressing sectors.

PubMed

Rémen, T; Acouetey, D-S; Paris, C; Hannhart, B; Poussel, M; Chenuel, B; Barbaud, A; Zmirou-Navier, D

2013-07-01

Occupational asthma (OA) is most likely to develop in the very early years of exposure. To describe the early incidence of OA among bakers/pastry-makers (BP) and hairdressers and to explore the role of atopy. Following a retrospective follow-up design, subjects were invited to undergo telephone interviews. Those who declared work-related respiratory or rhinitis symptoms and a sample group of others were offered a medical visit for OA investigations. Data from interviews and from medical visits were used to estimate the incidence of OA according to increasing durations of exposure. A total of 866 subjects were interviewed (mean age 25.3 years, 43.8% females), of whom 282 underwent a medical visit. Total estimated incidence rates of 'confirmed or probable' OA during the first 12 years of exposure were high in BP (2.63 per 100 person-years [py]) and in hairdressers (0.58/100 py), particularly in the first 4 years. Atopy is a strong risk factor for incidence among BP but, irrespective of the occupational sector, it does not influence the timing of OA symptoms. OA symptoms occur soon after the start of exposure. Our results suggest that atopy does not precipitate the occurrence of symptoms in two different allergen exposure settings.

Social and Physical Environmental Factors Influencing Adolescents' Physical Activity in Urban Public Open Spaces: A Qualitative Study Using Walk-Along Interviews.

PubMed

Van Hecke, Linde; Deforche, Benedicte; Van Dyck, Delfien; De Bourdeaudhuij, Ilse; Veitch, Jenny; Van Cauwenberg, Jelle

2016-01-01

Most previous studies examining physical activity in Public Open Spaces (POS) focused solely on the physical environment. However, according to socio-ecological models the social environment is important as well. The aim of this study was to determine which social and physical environmental factors affect adolescents' visitation and physical activity in POS in low-income neighbourhoods. Since current knowledge on this topic is limited, especially in Europe, qualitative walk-along interviews were used to obtain detailed and context-specific information. Participants (n = 30, aged 12-16 years, 64% boys) were recruited in POS in low-income neighbourhoods in Brussels, Ghent and Antwerp (Belgium). Participants were interviewed while walking in the POS with the interviewer. Using this method, the interviewer could observe and ask questions while the participant was actually experiencing the environment. All audio-recorded interviews were transcribed and analysed using Nvivo 10 software and thematic analysis was used to derive categories and subcategories using a grounded theory approach. The most important subcategories that were supportive of visiting POS and performing physical activity in POS were; accessibility by foot/bicycle/public transport, located close to home/school, presence of (active) friends and family, cleanliness of the POS and features, availability of sport and play facilities, large open spaces and beautiful sceneries. The most important subcategories that were unsupportive of visiting POS and physical activity in POS were; presence of undesirable users (drug users, gangs and homeless people), the behaviour of other users and the cleanliness of the POS and features. Social factors appeared often more influential than physical factors, however, it was the combination of social and physical factors that affected adolescents' behaviour in POS. Easily accessible POS with high quality features in the proximity of adolescents' home or school may stimulate physical activity, if adolescents also experience a safe and familiar social environment.

Social and Physical Environmental Factors Influencing Adolescents’ Physical Activity in Urban Public Open Spaces: A Qualitative Study Using Walk-Along Interviews

PubMed Central

Van Hecke, Linde; Deforche, Benedicte; Van Dyck, Delfien; De Bourdeaudhuij, Ilse; Veitch, Jenny; Van Cauwenberg, Jelle

2016-01-01

Most previous studies examining physical activity in Public Open Spaces (POS) focused solely on the physical environment. However, according to socio-ecological models the social environment is important as well. The aim of this study was to determine which social and physical environmental factors affect adolescents’ visitation and physical activity in POS in low-income neighbourhoods. Since current knowledge on this topic is limited, especially in Europe, qualitative walk-along interviews were used to obtain detailed and context-specific information. Participants (n = 30, aged 12–16 years, 64% boys) were recruited in POS in low-income neighbourhoods in Brussels, Ghent and Antwerp (Belgium). Participants were interviewed while walking in the POS with the interviewer. Using this method, the interviewer could observe and ask questions while the participant was actually experiencing the environment. All audio-recorded interviews were transcribed and analysed using Nvivo 10 software and thematic analysis was used to derive categories and subcategories using a grounded theory approach. The most important subcategories that were supportive of visiting POS and performing physical activity in POS were; accessibility by foot/bicycle/public transport, located close to home/school, presence of (active) friends and family, cleanliness of the POS and features, availability of sport and play facilities, large open spaces and beautiful sceneries. The most important subcategories that were unsupportive of visiting POS and physical activity in POS were; presence of undesirable users (drug users, gangs and homeless people), the behaviour of other users and the cleanliness of the POS and features. Social factors appeared often more influential than physical factors, however, it was the combination of social and physical factors that affected adolescents’ behaviour in POS. Easily accessible POS with high quality features in the proximity of adolescents’ home or school may stimulate physical activity, if adolescents also experience a safe and familiar social environment. PMID:27214385

1982 HHS/LIHEAP funds used for weatherization. An analysis of data from twenty states: Task A. Final report

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

Not Available

1983-05-01

During the Summer and Fall of 1982, Arawak Consulting Corporation monitored a number of program management functions of the Low Income Weatherization Assistance Program (WAP) in the 20 states under the jurisdiction of the DOE Chicago Operations Office. The monitoring included on-site visits to all 20 state grantees and 85 randomly selected local subgrantees. Although the monitoring was designed to focus only on the DOE funded program, it soon became apparent that funds from the Department of Health and Human Services' Low Income Home Energy Assistance Program (LIHEAP) often had a significant effect on the scope and mode of operationmore » of the weatherization program. As a result of these and other outcomes, DOE asked Arawak to further study the impact of HHS funds on the Weatherization Assistance Program in the same 20 states. This report is the result of that request. It draws on information collected during the monitoring visits which were conducted from mid-July to mid-October 1982, and on additional information obtained in telephone interviews during the last two weeks of February 1983.« less

Factors Affecting Attendance at and Timing of Formal Antenatal Care: Results from a Qualitative Study in Madang, Papua New Guinea

PubMed Central

Andrew, Erin V. W.; Pell, Christopher; Angwin, Angeline; Auwun, Alma; Daniels, Job; Mueller, Ivo; Phuanukoonnon, Suparat; Pool, Robert

2014-01-01

Background Appropriate antenatal care (ANC) is key for the health of mother and child. However, in Papua New Guinea (PNG), only a third of women receive any ANC during pregnancy. Drawing on qualitative research, this paper explores the influences on ANC attendance and timing of first visit in the Madang region of Papua New Guinea. Methods Data were collected in three sites utilizing several qualitative methods: free-listing and sorting of terms and definitions, focus group discussions, in-depth interviews, observation in health care facilities and case studies of pregnant women. Respondents included pregnant women, their relatives, biomedical and traditional health providers, opinion leaders and community members. Results Although generally reported to be important, respondents’ understanding of the procedures involved in ANC was limited. Factors influencing attendance fell into three main categories: accessibility, attitudes to ANC, and interpersonal issues. Although women saw accessibility (distance and cost) as a barrier, those who lived close to health facilities and could easily afford ANC also demonstrated poor attendance. Attitudes were shaped by previous experiences of ANC, such as waiting times, quality of care, and perceptions of preventative care and medical interventions during pregnancy. Interpersonal factors included relationships with healthcare providers, pregnancy disclosure, and family conflict. A desire to avoid repeat clinic visits, ideas about the strength of the fetus and parity were particularly relevant to the timing of first ANC visit. Conclusions This long-term in-depth study (the first of its kind in Madang, PNG) shows how socio-cultural and economic factors influence ANC attendance. These factors must be addressed to encourage timely ANC visits: interventions could focus on ANC delivery in health facilities, for example, by addressing healthcare staff’s attitudes towards pregnant women. PMID:24842484

Understanding why GPs see pharmaceutical representatives: a qualitative interview study.

PubMed Central

Prosser, Helen; Walley, Tom

2003-01-01

BACKGROUND: Doctors are aware of the commercial bias in pharmaceutical representative information; nevertheless, such information is known to change doctors' prescribing, and augment irrational prescribing and prescribing costs. AIM: To explore GPs, reasons for receiving visits from pharmaceutical representatives. DESIGN OF STUDY: Qualitative study with semi-structured interviews. SETTING: One hundred and seven general practitioners (GPs) in practices from two health authorities in the North West of England. RESULTS: The main outcome measures of the study were: reasons for receiving/not receiving representative visits; advantages/disadvantages in receiving visits; and quality of representative-supplied information. Most GPs routinely see pharmaceutical representatives, because they bring new drug information speedily; they are convenient and accessible; and can be consulted with a saving of time and effort. Many GPs asserted they had the skills to critically appraise the evidence. Furthermore, the credibility and social characteristics of the representative were instrumental in shaping GPs' perceptions of representatives as legitimate information providers. GPs also received visits from representatives for reasons other than information acquisition. These reasons are congruent with personal selling techniques used in marketing communications. CONCLUSIONS: The study draws attention to the social and cultural contexts of GP-representative encounters and the way in which the acquisition of pharmacological information within the mercantile context of representative visits is legitimated. This highlights the need for doctors to critically appraise information supplied by representatives in relation to other information sources. PMID:12879831

Occupational therapy during the first 10 years of rheumatoid arthritis.

PubMed

Malcus-Johnson, Pia; Carlqvist, Carin; Sturesson, Anna-Lena; Eberhardt, Kerstin

2005-01-01

To describe disease development and occupational therapy during the first 10 years of rheumatoid arthritis (RA), and to assess patients' experiences of occupational therapy and comprehensive care. A total of 168 early RA patients with variable disease severity were followed up with regular team visits. The occupational therapist evaluated hand function and activity and performed the necessary interventions. These were recorded and the number of visits generating interventions was calculated. Semi-structured interview of 11 patients regarding their views of occupational therapy and team contact was performed. Impairments of hand function were in general mild to moderate and remained fairly unchanged over time. Activity limitations increased slowly. Half of the follow-up visits generated interventions. Most common were prescriptions of assistive devices and orthoses, hand-training instructions and patient education. The patients interviewed were positive regarding occupational therapy and felt safe with comprehensive care. RA patients in all stages of the disease benefit from regular contact with an occupational therapist and team care.

Improving sexual risk communication with adolescents using event history calendars.

PubMed

Martyn, Kristy K; Darling-Fisher, Cynthia; Pardee, Michelle; Ronis, David L; Felicetti, Irene L; Saftner, Melissa A

2012-04-01

This study was conducted to explore the effects of an event history calendar (EHC) approach on adolescent sexual risk communication and sexual activity. Adolescent school-linked health clinic patients (n = 30) who reported sexual activity self-administered the EHC that was used by nurse practitioners (NPs; n = 2) during a clinic visit. Immediately pre- and post-visit, and at 1 and 3 months, adolescents reported sexual risk behaviors and perceptions about EHC communication on questionnaires and by interview. NPs reported their perceptions of EHCs by questionnaire after the visit and poststudy interview. The EHC approach facilitated communication and adolescent awareness of their risk behaviors. Scores increased on Amount of Communication, t(29) = 8.174, p < .001; Satisfaction with Communication, t(29) = 3.112, p = .004; Client Involvement in Decision Making, t(29) = 3.901, p = .001, and Client Satisfaction with Interpersonal Style, t(29) = 3.763, p = .001. Adolescents reported decreased sexual intercourse at 1 month, p = .031. School nurses could use the EHC approach to facilitate adolescent communication and tailoring of interventions.

Integrating Parenting Support Within and Beyond the Pediatric Medical Home.

PubMed

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

2018-01-01

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

Using qualitative mixed methods to study small health care organizations while maximising trustworthiness and authenticity.

PubMed

Phillips, Christine B; Dwan, Kathryn; Hepworth, Julie; Pearce, Christopher; Hall, Sally

2014-11-19

The primary health care sector delivers the majority of health care in western countries through small, community-based organizations. However, research into these healthcare organizations is limited by the time constraints and pressure facing them, and the concern by staff that research is peripheral to their work. We developed Q-RARA-Qualitative Rapid Appraisal, Rigorous Analysis-to study small, primary health care organizations in a way that is efficient, acceptable to participants and methodologically rigorous. Q-RARA comprises a site visit, semi-structured interviews, structured and unstructured observations, photographs, floor plans, and social scanning data. Data were collected over the course of one day per site and the qualitative analysis was integrated and iterative. We found Q-RARA to be acceptable to participants and effective in collecting data on organizational function in multiple sites without disrupting the practice, while maintaining a balance between speed and trustworthiness. The Q-RARA approach is capable of providing a richly textured, rigorous understanding of the processes of the primary care practice while also allowing researchers to develop an organizational perspective. For these reasons the approach is recommended for use in small-scale organizations both within and outside the primary health care sector.

Elders' Experiences During Return Visits to the Emergency Department: A Phenomenographic Study in Taiwan.

PubMed

Han, Chin-Yen; Lin, Chun-Chih; Goopy, Suzanne; Hsiao, Ya-Chu; Barnard, Alan

Elders often experience multiple chronic diseases associated with frequent early return visits to emergency departments (EDs). There is limited knowledge of the experiences and concerns of elders during ED return visits. The purpose of the research was to explore the experiences of elders during ED return visits, with a view toward identifying factors that contribute to return visits. The qualitative approach of phenomenography was used. Data were collected at one ED in a 3,000-bed medical center in Taiwan. Inclusion criteria were aged 65 or above and return visits to the ED within 72 hours of discharge from an index ED visit. The seven steps of qualitative data analysis for a phenomenographic study were employed to develop understanding of participants' experiences. Thirty return-visit elders were interviewed in 2014. Four categories of description were established from the participants' accounts. These were "being tricked by ED staff," "doctor shopping," "a sign of impending death," and "feeling fatalistic." The outcome space of elders with early return visits to ED was characterized as "seeking the answer." Index ED visits are linked to return visits for Taiwanese elders through physiological, psychological, and social factors.

Managing for recreational experience opportunities: the case of hikers in protected areas in Catalonia, Spain.

PubMed

Farías Torbidoni, Estela Inés

2011-03-01

Planning and management for recreational activities in protected areas involves an understanding of many complex factors. Segmentation of recreation demand and of the main physical or sporting activities can contribute to the design of more efficient management strategies, which may help to maintain or significantly enhance satisfaction with the recreation experience, and this in turn could improve the interest in and appreciation of the natural environment. The current study examined the motivations of hikers in three small Natura 2000 protected areas. It establishes a typology or categorization as a contribution to better management based on a survey conducted through on-site personal interviews with a representative sample of 569 hikers. Through an analysis of the principal intervening components by means of cluster analysis, we identified three groups of hikers based on three motivational dimensions: (1) nature-minded hikers, (2) sporting hikers and (3) general-purpose hikers. The most striking results were the significant differences among group variables related to visit behaviour (frequency and duration of visits and number of people per group), previous knowledge (protection status of the areas) and recreational frequentation (trail categories and protected areas visited). A positive correlation between the degree of sympathy for nature and the degree of satisfaction with the recreational experience (including positive evaluation of the public facilities, signposting and services offered) was also observed. The results are discussed in terms of their applicability and implications in hiking management in protected natural areas such as those of Natura 2000.

Managing for Recreational Experience Opportunities: The Case of Hikers in Protected Areas in Catalonia, Spain

NASA Astrophysics Data System (ADS)

Farías Torbidoni, Estela Inés

2011-03-01

Planning and management for recreational activities in protected areas involves an understanding of many complex factors. Segmentation of recreation demand and of the main physical or sporting activities can contribute to the design of more efficient management strategies, which may help to maintain or significantly enhance satisfaction with the recreation experience, and this in turn could improve the interest in and appreciation of the natural environment. The current study examined the motivations of hikers in three small Natura 2000 protected areas. It establishes a typology or categorization as a contribution to better management based on a survey conducted through on-site personal interviews with a representative sample of 569 hikers. Through an analysis of the principal intervening components by means of cluster analysis, we identified three groups of hikers based on three motivational dimensions: (1) nature-minded hikers, (2) sporting hikers and (3) general-purpose hikers. The most striking results were the significant differences among group variables related to visit behaviour (frequency and duration of visits and number of people per group), previous knowledge (protection status of the areas) and recreational frequentation (trail categories and protected areas visited). A positive correlation between the degree of sympathy for nature and the degree of satisfaction with the recreational experience (including positive evaluation of the public facilities, signposting and services offered) was also observed. The results are discussed in terms of their applicability and implications in hiking management in protected natural areas such as those of Natura 2000.

Health plan competition in local markets.

PubMed

Grossman, J M

2000-04-01

To examine the structure of local health insurance markets and the strategies health plans were using to respond to competitive pressures in local markets in 1996/1997. Community Tracking Study site visits conducted between May 1996 and April 1997 in 12 U.S. markets selected to be nationally representative. In each site, 36 to 60 interviews on local health system change were conducted with healthcare industry informants representing health plans, providers, and purchasers. Relevant data for this article were abstracted from standardized protocols administered to multiple respondents in each site. Although the competitive threat from national plans was pervasive, local plans in most sites continued to retain strong, often dominant, positions in historically concentrated markets. In all sites, in response to purchaser pressures for stable premiums and provider choice, and the threat of entry and to plans were using three strategies to increase market share and market power: (1) consolidation/geographic expansion, (2) price competition, and (3) product line/segment diversification that focused on broad networks and open-access products. In most markets, in response to the demand for provider choice, the trend was away from ownership and exclusive arrangements with providers. Although local plans were moving to become full-service regional players, there was uncertainty about the abilities of all plans to sustain growth strategies at the expense of margins and organizational stability, and to effectively manage care with broad networks.

An Outsider View: The Perceptions of Visiting International Students on Teaching, Language and Culture

ERIC Educational Resources Information Center

Bavli, Bünyamin

2017-01-01

This study investigates how international visitor students studying temporarily at a public university in Turkey perceive teaching, language and culture. Qualitative explanatory single case study method was employed in the study. The data were obtained through face to face interview with 10 participants, and a focus group interview with 3…

ISS Expedition 42 / 43 Soyuz Spacecraft and Crew Preparations for Launch

NASA Image and Video Library

2014-11-26

NASA TV (NTV) video file of crewmembers Terry Virts, Anton Shkaplerov (Roskosmos) and Samantha Cristoforetti (ESA) during final fit check of the Soyuz TMA 15M spacedraft at the Integration Facility, Baikonurk, Kazakhstan. Includes footage of the crew climbing into the Soyuz spacecraft, interviews, visit to museum where the crew sign posters and a flag; flag raising ceremony; and visit to mating facility.

Mortuary Science Programs: Examination of the External Evaluation Team

ERIC Educational Resources Information Center

Reinhard, D. Elaine

2010-01-01

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

Places to Go: Sakai|http://www.sakaiproject.org/

ERIC Educational Resources Information Center

Downes, Stephen

2006-01-01

Stephen Downes continues his examination of open source learning management systems (LMSs) with a visit to Sakai's Web site. While Sakai's Web site is not particularly easy to navigate, it provides access to a large community and constellation of related online learning products and initiatives. Visitors can visit discussion forums to ask…

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-17

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

Levels of Nature and Stress Response

PubMed Central

2018-01-01

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

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

PubMed Central

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

2009-01-01

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

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

Treesearch

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

2003-01-01

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

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

ERIC Educational Resources Information Center

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

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

Physicians' perceptions of medical representative visits in Yemen: a qualitative study.

PubMed

Al-Areefi, Mahmoud Abdullah; Hassali, Mohamed Azmi; Ibrahim, Mohamed Izham b Mohamed

2013-08-20

The pharmaceutical industry invests heavily in promotion, and it uses a variety of promotional strategies to influence physicians' prescribing decisions. Within this context, medical representatives (MRs) are the key personnel employed in promoting their products. One significant consequence of the interactions between physicians and medical representatives is a conflict of interests which may contribute to the over prescribing of medications and thus negative effects on patients' health and economics. There is limited detailed information published on the reasons why physicians interact with pharmaceutical representatives. This study aims to qualitatively explore physicians' attitudes about interactions with medical representatives and their reasons for accepting the medical representatives' visits. In-depth interviews were used to gain a better understanding of physicians' perceptions of medical representative visits. A total of 32 physicians from both private and public hospitals were interviewed. The recordings of the interviews were transcribed verbatim and subject to thematic analysis using a framework analysis approach. The present qualitative study found that the majority of the physicians had positive interactions with medical representatives. The physicians' main reasons stated for allowing medical representatives' visits are the social contacts and mutual benefits they will gain from these representatives. They also emphasized that the meeting with representatives provides educational and scientific benefits. A few physicians stated that the main reasons behind refusing the meeting with medical representatives were lack of conviction about the product and obligation to prescribe medicine from the representative company. Most of the physicians believed that they were under marketing pressure to prescribe certain medicines. Although physicians are aware that the medical representatives could influence their prescribing decision, they welcome representatives to visit them and consider receiving free samples, gifts and various kinds of support as a normal practice. The findings provided insight into possible target areas for educational interventions concerning pharmaceutical marketing. Such a finding will provide the basis for policymakers in the public and private health sector in Yemen to develop a suitable policy and regulations in terms of drug promotion.

Home Visiting for Adolescent Mothers: Effects on Parenting, Maternal Life Course, and Primary Care Linkage

PubMed Central

Barnet, Beth; Liu, Jiexin; DeVoe, Margo; Alperovitz-Bichell, Kari; Duggan, Anne K.

2007-01-01

PURPOSE Adolescent mothers are at risk for rapidly becoming pregnant again and for depression, school dropout, and poor parenting. We evaluated the impact of a community-based home-visiting program on these outcomes and on linking the adolescents with primary care. METHODS Pregnant adolescents aged 12 to 18 years, predominantly with low incomes and of African American race, were recruited from urban prenatal care sites and randomly assigned to home visiting or usual care. Trained home visitors, recruited from local communities, were paired with each adolescent and provided services through the child’s second birthday. They delivered a parenting curriculum, encouraged contraceptive use, connected the teen with primary care, and promoted school continuation. Research assistants collected data via structured interviews at baseline and at 1 and 2 years of follow-up using validated instruments to measure parenting (Adult-Adolescent Parenting Inventory) and depression (Center for Epidemiologic Studies Depression). School status and repeat pregnancy were self-reported. We measured program impact over time with intention-to-treat analyses using generalized estimating equations (GEE). RESULTS Of 122 eligible pregnant adolescents, 84 consented, completed baseline assessments, and were randomized to a home-visited group (n = 44) or a control group (n = 40). Eighty-three percent completed year 1 or year 2 follow-up assessments, or both. With GEE, controlling for baseline differences, follow-up parenting scores for home-visited teens were 5.5 points higher than those for control teens (95% confidence interval, 0.5–10.4 points; P = .03) and their adjusted odds of school continuation were 3.5 times greater (95% confidence interval, 1.1–11.8; P <.05). The program did not have any impact on repeat pregnancy, depression, or linkage with primary care. CONCLUSIONS This community-based home-visiting program improved adolescent mothers’ parenting attitudes and school continuation, but it did not reduce their odds of repeat pregnancy or depression or achieve coordination with primary care. Coordinated care may require explicit mechanisms to promote communication between the community program and primary care. PMID:17548850

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

PubMed

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

2003-10-01

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

Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach.

PubMed

Geng, Elvin H; Bangsberg, David R; Musinguzi, Nicolas; Emenyonu, Nneka; Bwana, Mwebesa Bosco; Yiannoutsos, Constantin T; Glidden, David V; Deeks, Steven G; Martin, Jeffrey N

2010-03-01

Losses to follow-up after initiation of antiretroviral therapy (ART) are common in Africa and are a considerable obstacle to understanding the effectiveness of nascent treatment programs. We sought to characterize, through a sampling-based approach, reasons for and outcomes of patients who become lost to follow-up. Cohort study. We searched for and interviewed a representative sample of lost patients or close informants in the community to determine reasons for and outcomes among lost patients. Three thousand six hundred twenty-eight HIV-infected adults initiated ART between January 1, 2004 and September 30, 2007 in Mbarara, Uganda. Eight hundred twenty-nine became lost to follow-up (cumulative incidence at 1, 2, and 3 years of 16%, 30%, and 39%). We sought a representative sample of 128 lost patients in the community and ascertained vital status in 111 (87%). Top reasons for loss included lack of transportation or money and work/child care responsibilities. Among the 111 lost patients who had their vital status ascertained through tracking, 32 deaths occurred (cumulative 1-year incidence 36%); mortality was highest shortly after the last clinic visit. Lower pre-ART CD4 T-cell count, older age, low blood pressure, and a central nervous system syndrome at the last clinic visit predicted deaths. Of patients directly interviewed, 83% were in care at another clinic and 71% were still using ART. Sociostructural factors are the primary reasons for loss to follow-up. Outcomes among the lost are heterogeneous: both deaths and transfers to other clinics were common. Tracking a sample of lost patients is an efficient means for programs to understand site-specific reasons for and outcomes among patients lost to follow-up.

Feasibility of a pilot intervention to reduce pain and syncope during adolescent vaccination.

PubMed

Henninger, Michelle L; Kuntz, Jennifer L; Firemark, Alison J; Varga, Alexandra M; Bok, Karin; Naleway, Allison L

2018-05-24

Vaccines recommended for adolescents are considered safe and effective, however administration may occasionally result in acute pain at the injection site or syncope (fainting). These adverse effects pose a risk to patient safety and are potential barriers to adherence to future vaccinations. We assessed a novel intervention designed to help prevent acute pain and syncope associated with adolescent vaccinations. We conducted a 3-month pilot study to assess the feasibility and acceptability of a vaccination comfort menu within two Kaiser Permanente Northwest pediatric clinics. The menu offered a variety of comfort items (e.g., cold packs, squeeze balls) that children could select prior to their vaccination. We surveyed parents of recently vaccinated adolescents and interviewed providers to assess the implementation and effectiveness of the intervention. Response rate for the parent survey was 33% (378/1136). Only 20% of the parents reported that their provider offered the comfort menu during the vaccination visit. Approximately 50% of the adolescents who were offered the menu selected a comfort item and most of these participants reported that the item was very (35%) or somewhat (38%) helpful in improving their vaccination experience. Per provider interviews, common barriers to implementing the intervention included lack of time and convenience, and the brevity of the pilot period. The comfort menu may improve the vaccination experience of youth and increase the likelihood of adherence with future vaccinations. However, only 20% of the parents reported that their provider offered the menu during the vaccination visit. Additional research is needed to determine the feasibility of implementing this intervention on a larger scale, as well as assessing whether the intervention has a significant impact on reducing adverse events. Copyright © 2018. Published by Elsevier Ltd.

Cancer Health Empowerment for Living without Pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment.

PubMed

Kravitz, Richard L; Tancredi, Daniel J; Grennan, Tim; Kalauokalani, Donna; Street, Richard L; Slee, Christina K; Wun, Ted; Oliver, Jennifer Wright; Lorig, Kate; Franks, Peter

2011-07-01

We aimed to determine the effectiveness of a lay-administered tailored education and coaching (TEC) intervention (aimed at reducing pain misconceptions and enhancing self-efficacy for communicating with physicians) on cancer pain severity, pain-related impairment, and quality of life. Cancer patients with baseline "worst pain" of ≥4 on a 0-10 scale or at least moderate functional impairment due to pain were randomly assigned to TEC or enhanced usual care (EUC) during a telephone interview conducted in advance of a planned oncology office visit (265 patients randomized to TEC or EUC; 258 completed at least one follow-up). Patients completed questionnaires before and after the visit and were interviewed by telephone at 2, 6, and 12 weeks. Mixed effects regressions were used to evaluate the intervention adjusting for patient, practice, and site characteristics. Compared to EUC, TEC was associated with increased pain communication self-efficacy after the intervention (P<.001); both groups showed significant (P<.0001), similar, reductions in pain misconceptions. At 2 weeks, assignment to TEC was associated with improvement in pain-related impairment (-0.25 points on a 5-point scale, 95% confidence interval -0.43 to -0.06, P=.01) but not in pain severity (-0.21 points on an 11-point scale, -0.60 to 0.17, P=.27). The improvement in pain-related impairment was not sustained at 6 and 12 weeks. There were no significant intervention by subgroup interactions (P>.10). We conclude that TEC, compared with EUC, resulted in improved pain communication self-efficacy and temporary improvement in pain-related impairment, but no improvement in pain severity. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Process, cost, and clinical quality: the initial oral contraceptive visit.

PubMed

McMullen, Michael J; Woolford, Samuel W; Moore, Charles L; Berger, Barry M

2013-01-01

To demonstrate how the analysis of clinical process, cost, and outcomes can identify healthcare improvements that reduce cost without sacrificing quality, using the example of the initial visit associated with oral contraceptive pill use. Cross-sectional study using data collected by HealthMETRICS between 1996 and 2009. Using data collected from 106 sites in 24 states, the unintended pregnancy (UIP) rate, effectiveness of patient education, and unit visit cost were calculated. Staff type providing education and placement of education were recorded. Two-way analysis of variance models were created and tested for significance to identify differences between groups. Sites using nonclinical staff to provide education outside the exam were associated with lower cost, higher education scores, and a UIP rate no different from that of sites using clinical staff. Sites also providing patient education during the physical examination were associated with higher cost, lower education scores, and a UIP rate no lower than that of sites providing education outside of the exam. Through analyzing process, cost, and quality, lower-cost processes that did not reduce clinical quality were identified. This methodology is applicable to other clinical services for identifying low-cost processes that do not result in lower clinical quality. By using nonclinical staff educators to provide education outside of the physical examination, sites could save an average of 32% of the total cost of the visit.

Piloting a Statewide Home Visiting Quality Improvement Learning Collaborative.

PubMed

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

2017-02-01

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

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

PubMed Central

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

2018-01-01

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

Study of New Youth Initiatives in Apprenticeship. Interim Report. Volume 1: Summary and Issues.

ERIC Educational Resources Information Center

CSR, Inc., Washington, DC.

This first volume of the interim report on the Study of New Youth Initiatives in Apprenticeship presents a discussion of site visit findings and implementation issues related to the United States Department of Labor's Apprenticeship-School Linkage Demonstrations. (Volume 2, site visit reports, is available separately as CE 032 792.) Chapter 1…

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-20

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

Variations in the implementation and characteristics of chiropractic services in VA.

PubMed

Lisi, Anthony J; Khorsan, Raheleh; Smith, Monica M; Mittman, Brian S

2014-12-01

In 2004, the US Department of Veterans Affairs expanded its delivery of chiropractic care by establishing onsite chiropractic clinics at select facilities across the country. Systematic information regarding the planning and implementation of these clinics and describing their features and performance is lacking. To document the planning, implementation, key features and performance of VA chiropractic clinics, and to identify variations and their underlying causes and key consequences as well as their implications for policy, practice, and research on the introduction of new clinical services into integrated health care delivery systems. Comparative case study of 7 clinics involving site visit-based and telephone-based interviews with 118 key stakeholders, including VA clinicians, clinical leaders and administrative staff, and selected external stakeholders, as well as reviews of key documents and administrative data on clinic performance and service delivery. Interviews were recorded, transcribed, and analyzed using a mixed inductive (exploratory) and deductive approach. Interview data revealed considerable variations in clinic planning and implementation processes and clinic features, as well as perceptions of clinic performance and quality. Administrative data showed high variation in patterns of clinic patient care volume over time. A facility's initial willingness to establish a chiropractic clinic, along with a higher degree of perceived evidence-based and collegial attributes of the facility chiropractor, emerged as key factors associated with higher and more consistent delivery of chiropractic services and higher perceived quality of those services.

Access to health care for uninsured Latina immigrants in South Carolina.

PubMed

Luque, John S; Soulen, Grace; Davila, Caroline B; Cartmell, Kathleen

2018-05-02

South Carolina is considered a "new destination" state for Latino immigrants. Language barriers, transportation difficulties, low socioeconomic status, inflexible work schedules, different cultural norms, and anxiety and fear related to the current anti-immigrant political climate all negatively impact Latino immigrants' frequency of contact with the health care system, and consequently they suffer poor health outcomes. The study objective was to explore uninsured Latina immigrant women's access to health care and alternative treatment strategies in coastal South Carolina. The study design was a qualitative interview design. Thirty women participated in semi-structured interviews in community sites. Thematic analysis identified salient categories of topics across interview participants. The themes were organized into four primary categories including: 1) Barriers and Facilitators to Healthcare, 2) Health Behaviors and Coping Mechanisms, 3) Disease Management Strategies, and 4) Cultural Factors. Participants demonstrated determination for accessing care but reported that their primary health care access barriers included the high cost of services, lack of health insurance, family and work responsibilities, and language barriers. Coping mechanisms included activating their social networks, visiting family and friends and assisting one another with navigating life challenges. Participants overcame obstacles to obtain healthcare for themselves and their family members despite the multiple barriers presented. Social networks were leveraged to protect against some of the negative effects of financial barriers to health care access.

An empty toolbox? Changes in health plans' approaches for managing costs and care.

PubMed

Mays, Glen P; Hurley, Robert E; Grossman, Joy M

2003-02-01

To examine how health plans have changed their approaches for managing costs and utilization in the wake of the recent backlash against managed care. Semistructured interviews with health plan executives, employers, providers, and other health care decision makers in 12 metropolitan areas that were randomly selected to be nationally representative of communities with more than 200,000 residents. Longitudinal data were collected as part of the Community Tracking Study during three rounds of site visits in 1996-1997, 1998-1999, and 2000-2001. Interviews probed about changes in the design and operation of health insurance products--including provider contracting and network development, benefit packages, and utilization management processes--and about the rationale and perceived impact of these changes. Data from more than 850 interviews were coded, extracted, and analyzed using computerized text analysis software. Health plans have begun to scale back or abandon their use of selected managed care tools in most communities, with selective contracting and risk contracting practices fading most rapidly and completely. In turn, plans increasingly have sought cost savings by shifting costs to consumers. Some plans have begun to experiment with new provider networks, payment systems, and referral practices designed to lower costs and improve service delivery. These changes promise to lighten administrative and financial burdens for physicians and hospitals, but they also threaten to increase consumers' financial burdens.

Highly effective cystic fibrosis clinical research teams: critical success factors.

PubMed

Retsch-Bogart, George Z; Van Dalfsen, Jill M; Marshall, Bruce C; George, Cynthia; Pilewski, Joseph M; Nelson, Eugene C; Goss, Christopher H; Ramsey, Bonnie W

2014-08-01

Bringing new therapies to patients with rare diseases depends in part on optimizing clinical trial conduct through efficient study start-up processes and rapid enrollment. Suboptimal execution of clinical trials in academic medical centers not only results in high cost to institutions and sponsors, but also delays the availability of new therapies. Addressing the factors that contribute to poor outcomes requires novel, systematic approaches tailored to the institution and disease under study. To use clinical trial performance metrics data analysis to select high-performing cystic fibrosis (CF) clinical research teams and then identify factors contributing to their success. Mixed-methods research, including semi-structured qualitative interviews of high-performing research teams. CF research teams at nine clinical centers from the CF Foundation Therapeutics Development Network. Survey of site characteristics, direct observation of team meetings and facilities, and semi-structured interviews with clinical research team members and institutional program managers and leaders in clinical research. Critical success factors noted at all nine high-performing centers were: 1) strong leadership, 2) established and effective communication within the research team and with the clinical care team, and 3) adequate staff. Other frequent characteristics included a mature culture of research, customer service orientation in interactions with study participants, shared efficient processes, continuous process improvement activities, and a businesslike approach to clinical research. Clinical research metrics allowed identification of high-performing clinical research teams. Site visits identified several critical factors leading to highly successful teams that may help other clinical research teams improve clinical trial performance.

Communicating about chemotherapy-induced anemia.

PubMed

Davidson, Brad; Blum, Diane; Cella, David; Hamilton, Heidi; Nail, Lillian; Waltzman, Roger

2007-01-01

Many validated instruments exist for determining the impact of chemotherapy-induced anemia and related fatigue on patient quality of life, but few studies analyze how healthcare providers actually discuss these subjects with patients. The authors share their study results on patterns of communication between participating patients and their physicians and allied health professionals. Letters of invitation were mailed to over 1,000 community-based oncologists, 15 of whom met the criteria and agreed to participate in this study on a first-enrolled basis until sufficient participation was ensured. In total, 36 of their patients were audio- and/or video-recorded during their regularly scheduled visits. Post-visit interviews were conducted separately with patients and participating healthcare professionals. Interviews were transcribed and analyzed using sociolinguistic techniques. Although 52% of visit time was spent discussing side effects and symptoms, most discussions of anemia and fatigue lacked specificity necessary to determine their true impact on patients' lives. Physician inquiries regarding fatigue also tended to be too brief to elicit patients' chief concerns. Vocabulary used to discuss anemia and related fatigue was variable and imprecise, and no fatigue assessment instrument was used or referenced in any visit. Community-based oncologists are encouraged to modify their vocabulary and consider incorporating a validated fatigue instrument, either within or before the consultation, to improve the quality of such communication.

September 2011 DMM Podcast: an interview with Irv Weissman

PubMed Central

2011-01-01

SUMMARY This podcast includes excerpts from an interview with Irv Weissman, of Stanford University, in which he recalls his early years studying immunology in mice and discusses more recent challenges he has faced when attempting to develop stem-cell-based therapies with industry. Narrated by Sarah E. Allan. To listen to this podcast, visit http://www.biologists.com/DMM/podcasts/index.html.

Sensory coding of nest-site value in honeybee swarms.

PubMed

Seeley, Thomas D; Visscher, P Kirk

2008-12-01

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

Assessing the impact of a web-based comprehensive somatic and mental health screening tool in pediatric primary care.

PubMed

Fothergill, Kate E; Gadomski, Anne; Solomon, Barry S; Olson, Ardis L; Gaffney, Cecelia A; Dosreis, Susan; Wissow, Lawrence S

2013-01-01

To evaluate how parents and physicians perceive the utility of a comprehensive, electronic previsit screener, and to assess its impact on the visit. A mixed methods design was used. English-speaking parents were recruited from 3 primary care systems (urban MD and rural NY and VT) when they presented for a well-child visit with a child 4 to 10 years of age. Parents completed an electronic previsit screen, which included somatic concerns, health risks, and 4 mental health tools (SCARED5, PHQ-2, SDQ Impact, and PSC-17). Parents completed an exit survey, and a subset were interviewed. All primary care providers (PCPs) were interviewed. A total of 120 parents and 16 PCPs participated. The exit surveys showed that nearly 90% of parents agreed or strongly agreed that the screener was easy to use and maintained confidentiality. During interviews, parents noted that the screener helped with recall, validated concerns, reframed issues they thought might not be appropriate for primary care, and raised new questions. PCPs thought that the screener enabled them to normalize sensitive issues, and it permitted them to simultaneously focus and be comprehensive during the visit. Parents and PCPs agreed that the screener helped guide discussion, promoted in-depth exchange, and increased efficiency. Findings were consistent across quantitative and qualitative methods and between parents and PCPs. A comprehensive electronic previsit screening tool is an acceptable and practical strategy to facilitate well-child visits. It may help with problem identification as well as with setting agendas, engaging the family, and balancing attention between somatic and psychosocial concerns. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Health care and social service professionals' perceptions of a home-visit program for young, first-time mothers.

PubMed

Li, S A; Jack, S M; Gonzalez, A; Duku, E; MacMillan, H L

2015-01-01

Little is known about health care and social service professionals' perspective on the acceptability of long-term home-visit programs serving low-income, first-time mothers. This study describes the experiences and perspectives of these community care providers involved with program referrals or service delivery to mothers who participated in the Nurse-Family Partnership (NFP), a targeted nurse home-visit program. The study included two phases. Phase I was a secondary qualitative data analysis used to analyze a purposeful sample of 24 individual interviews of community care providers. This was part of a larger case study examining adaptations required to increase acceptability of the NFP in Hamilton, Ontario, Canada. In Phase II (n = 4), themes identified from Phase I were further explored through individual, semi-structured interviews with community health care and social service providers, giving qualitative description. Overall, the NFP was viewed as addressing an important service gap for first-time mothers. Providers suggested that frequent communication between the NFP and community agencies serving these mothers could help improve the referral process, avoid service duplication, and streamline the flow of service access. The findings can help determine key components required to enhance the success of integrating a home-visit program into an existing network of community services. The function of home-visit programs should not be viewed in isolation. Rather, their potential can be maximized when they collaborate and share information with other agencies to provide better services for first-time mothers.

Geo-Statistical Approach to Estimating Asteroid Exploration Parameters

NASA Technical Reports Server (NTRS)

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

2011-01-01

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

Catalog of known hot springs and thermal place names for Honduras

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

Finch, R.C.

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

Patterns and determinants of maternity care in Damascus.

PubMed

Bashour, H; Abdulsalam, A; Al-Faisal, W; Cheikha, S

2008-01-01

This descriptive study was designed to describe the patterns and determinants of maternity care among Syrian women living in Damascus. All 39 birth registers in 2 large provinces were used to recruit 500 mothers of healthy newborns. Mothers were interviewed in their homes using a semistructured questionnaire. Multivariate analysis of the determinants of the frequency of use of antenatal care showed the following variables were significant: urban residence and visit to antenatal care in the 1st trimester. The significant variables for an early visit to antenatal care were the woman's level of education; being pregnant with the 1st baby; and number of visits to antenatal care. Being young (age < 20 years) also correlated with early timing of the 1st antenatal visit.

HPV vaccination: Pilot study assessing characteristics of high and low performing primary care offices.

PubMed

Lollier, Allison; Rodriguez, Elisa M; Saad-Harfouche, Frances G; Widman, Christy A; Mahoney, Martin C

2018-06-01

This pilot study was undertaken to identify characteristics and approaches (e.g., social, behavioral, and/or systems factors) which differentiate primary care medical offices achieving higher rates of HPV vaccination. Eligible primary care practice sites providing care to adolescent patients were recruited within an eight county region of western New York State between June 2016 and July 2016. Practice sites were categorized as higher (n = 3) or lower performing (n = 2) based on three dose series completion rates for HPV vaccinations among females aged 13-17 years. Interviewer administered surveys were completed with office staff (n = 37) and focused on understanding approaches to adolescent vaccination. Results were summarized using basic descriptive statistics. Higher performing offices reported more full-time clinical staff (median = 25 vs. 9.5 in lower performing clinics), larger panels of patients ages 11-17 years (median = 3541 vs. 925) and completion of NYSIIS data entry within two weeks of vaccination. (less than a month vs. two). Staff in higher performing offices reviewed medical charts prior to scheduled visits (100% vs. 50) and identified their office vaccine champion as a physician and/or a nurse manager (75% vs. 22%). Also, staffs from higher performing offices were more likely to report the combination of having an office vaccine champion, previewing charts and using standing orders. These preliminary findings support future research examining implementation of organizational processes including identifying a vaccine champion, using standing orders and previewing medical charts prior to office visits as strategies to increase rates of HPV vaccination in primary care offices.

Women's experiences of health visitor delivered listening visits as a treatment for postnatal depression: a qualitative study.

PubMed

Turner, Katrina M; Chew-Graham, Carolyn; Folkes, Liz; Sharp, Deborah

2010-02-01

To explore women's experiences of health visitor delivered listening visits as a treatment for postnatal depression. In-depth interviews with 22 women who had received listening visits as a treatment for postnatal depression. All the women reported the visits as beneficial, although many of them had required additional intervention to manage their symptoms. Women who had a previous history of depression and women whose depression was not attributed to events in the postnatal period perceived the listening visits to be less beneficial. Receiving visits from a research health visitor, rather than their practice health visitor, was felt to be advantageous. Women with postnatal depression may report listening visits as helpful but insufficient to manage their depression. The extent to which women report listening visits as beneficial appears to be linked to the causes of their depression, the way in which the visits are delivered and by whom. Practitioners managing women with postnatal depression should discuss possible causes and previous episodes of depression before suggesting listening visits as a treatment. They need to explain what the visits will entail, ensure that additional types of treatment remain available and encourage women to utilise other forms of support. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Aviation human factors research in US universities: Potential contributions to national needs

NASA Technical Reports Server (NTRS)

Dismukes, R. Key

1994-01-01

Universities can and should make vital contributions to national needs in aviation human factors. However, to guide and utilize university research effectively we must understand what types of expertise and facilities universities can bring to bear on aviation problems. We should be aware of where relevant research is already underway and where untapped potential exists. How does the character of research in universities differ from and complement research in government and industry laboratories? What conditions would encourage universities to focus on national priorities and would promote high quality, relevant research? This paper attempts to address these issues. It is based on a survey conducted by the author, which included site visits to several universities, telephone interviews with faculty members at other universities, and a search of the aviation human factors research literature.

"Birth Control can Easily Take a Back Seat": Challenges Providing IUDs in Community Health Care Settings.

PubMed

Biggs, M Antonia; Kaller, Shelly; Harper, Cynthia C; Freedman, Lori; Mays, Aisha R

2018-01-01

To assess community health centers' (CHCs) capacity to offer streamlined intrauterine devices (IUDs) services. Prior to implementing a contraceptive training project, we surveyed health care staff (N=97) from 11 CHC sites that offer IUDs onsite. Twenty interviews with clinicians explored more deeply their challenges offering IUDs in the CHC setting. Most practices required multiple visits for IUD placement, most (66%) clinician survey respondents had placed an IUD and 19% had placed an IUD as emergency contraception. Need for screening tests, scheduling challenges, pressures to meet patient quotas, and lack of priority given to women's health hindered streamlined IUD provision. Although access to IUDs has increased, significant barriers to provision in CHC settings persist. Clinic policies may need to address a variety of system and provider-level barriers to meet the needs of patients.

Republic of the Marshall Islands assessment for a continuing health care professional development program.

PubMed

Langidrik, Justina R; Riklon, Sheldon; Lanwi, Salome; Gunawardane, Kamal; Soe, Tin; Jack, Tom; Balaoing, Grace Ann; Buenconsejo-Lum, Lee E

2007-03-01

In 2003, the University of Hawai'i Department of Family Medicine and Community Health entered a 4-year cooperative agreement with the U.S. Health Resources and Services Administration to establish the "Pacific Association for Clinical Training" (PACT). PACT's goal is to develop effective distance education methods to improve the education and skills of healthcare professionals in the U.S.-Affiliated Pacific Island nations. To determine the situation existing in 2004, one of PACT's first projects was to perform site visits to each jurisdiction, conducting needs assessments through interviews with key health care professionals, hospital administrators, and government officials. This article highlights findings of PACT's assessment of Republic of the Marshall Islands. Meant to establish a baseline for future reference, all data are those collected in 2004/2005 and have not been updated.

Effect of the Clean Water Act on shellfish growing waters in the Gulf of Mexico

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

Broutman, M.A.

1988-01-01

This report examines the classification of shellfish growing waters in the Gulf of Mexico as an indicator of bacterial water quality. Information presented includes the status of classified waters, sources of pollution affecting waters that are not classified as approved, and trends in classification between 1971 and 1985. Data were collected by site visits to the five Gulf states, interviews with state personnel, and reference to written materials. Data are used to assess the effectiveness of national efforts to improve bacterial water quality in the past fifteen years since passage of the Clean Water Act. The hypothesis to be testedmore » is that these efforts have not succeeded in reducing fecal coliform concentrations to levels required for approved harvest of shellfish, as established by the National Shellfish Sanitation Program.« less

Informed Strangers: Witnessing and Responding to Unethical Care as Student Nurses

PubMed Central

Engel, Joyce; Salfi, Jenn; Micsinszki, Samantha; Bodnar, Andrea

2017-01-01

Nursing students occupy a unique perspective in clinical settings because they are informed, through education, about how patient care ought to happen. Given the brevity of placements and their “visiting status” in clinical sites, students are less invested in the ethos of specific sites. Subsequently, their perspectives of quality care are informed by what should happen, which might differ from that of nurses and patients. The purpose of this study was to identify predominant themes in patient care, as experienced by students, and the influence that these observations have on the development of their ethical reasoning. Using a qualitative descriptive approach in which 27 nursing student papers and three follow-up in-depth interviews were analyzed, three main themes emerged: Good employee, poor nurse; damaged care; and negotiating the gap. The analysis of the ethical situations in these papers suggests that students sometimes observe care that lacks concern for the dignity, autonomy, and safety of patients. For these student nurses, this tension led to uncertainty about patient care and their eventual profession. PMID:28932765

Manual handling of highway kerbs--focus group findings.

PubMed

Bust, P D; Gibb, A G F; Haslam, R A

2005-07-01

The manual handling of concrete highway kerbs remains commonplace in the construction industry despite obvious risks to operatives. This study was undertaken to find out why kerb installation still includes manual handling, to identify the alternatives that exist and to consider how the organisation of the work affects exposure to risk. Focus groups were held with industry professionals to discuss kerb design, installation and the training of operatives, with site visits and interviews undertaken to place the focus group findings in context. The focus group discussions highlighted manufacturer's "myopia", a lack of installation knowledge of designers and shortfalls in training for installation work. It was concluded that risks to the health of construction workers remain as they are not considered in the design of the product, design of the work or ameliorated by adequate risk assessment. Recommendations from the research are that a pro-active approach to health needs to be adopted by the manufacturers of heavy construction products. Designers of work requiring the use of heavy products need to have more experience of site operations, and education and training in manual handling is desirable at all levels in construction organisations.

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

PubMed

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

2017-07-01

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

"Let him speak:" a descriptive qualitative study of the roles and behaviors of family companions in primary care visits among older adults with cognitive impairment.

PubMed

Vick, Judith B; Amjad, Halima; Smith, Katherine C; Boyd, Cynthia M; Gitlin, Laura N; Roth, David L; Roter, Debra L; Wolff, Jennifer L

2018-01-01

Cognitive impairment poses communication challenges in primary care. Although family "companions" commonly attend primary care visits of older adults with cognitive impairment, little is known about how their involvement affects communication. Therefore, we sought to understand how companion involvement affects the quality of primary care visit communication for older adults with cognitive impairment. Cross-sectional, descriptive qualitative study participants were as follows: (1) English-speaking adults age 65 or older with mild, moderate, or severe cognitive impairment; (2) family members or other unpaid companions who accompany older adults to primary care visits; and (3) primary care clinicians. Twenty semi-structured and in-depth qualitative interviews of older adults and their companions (N = 20 dyads) and two focus groups (N = 10 primary care clinicians) were conducted. Interviews and focus groups were transcribed and analyzed thematically. Family companions commonly facilitate communication by advocating for patients, ensuring the accuracy of information exchange and understanding, and preserving rapport. Significant communication challenges were also identified, including patient and companion role ambiguity, competing visit agendas, and primary care clinician confusion regarding the most accurate source of information. Patients, companions, and clinicians each identified strategies to improve communication, chief among them being to identify, differentiate, and respect both patient and companion priorities and perspectives. Family companions actively participate in primary care visits of older adults with cognitive impairment in ways that promote and inhibit effective communication. Findings suggest the need for strategies that more effectively and purposefully involve family in the care of primary care patients with cognitive impairment. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Frequent users of rural primary care: comparisons with randomly selected users.

PubMed

Mehl-Madrona, L E

1998-01-01

Frequent users of primary care have not been adequately characterized. The unique characteristics of this population was sought--why they come so often, what their care costs, and whether psychosocial factors play a role in their high utilization of health care. The billing system of a rural primary care clinic was used to find the frequency of visits for all patients attending the clinic for the previous 12 months. The 211 most frequent visitors were selected. A comparison group of 250 patients was drawn from the billing records using a random number generator. Charts were reviewed to compare diagnoses (by frequency), number of procedures, amount billed for care, amount received from those billings, number of psychotropic medications prescribed, and response to medication. A subgroup of each group was interviewed to confirm chart review findings and to inquire about personal reasons for coming to the clinic. Compared with patients who were random users, patients who were frequent users were more likely to come from the younger and older age groups, they averaged significantly more emergency department visits and visits to other specialists (P < 0.0001), and they had more mental health problems diagnosed (P < 0.01). Significantly more frequent users were insured by Medicaid and fewer were insured by Medicare. They had more detailed office visits and more laboratory tests. They received twice as much psychotherapy and had a higher percentage of problem-focused office visits. Chart audits and interviews of selected patients revealed that many nonmedical reasons were related to visits in addition to psychosocial stressors. Nonmedical factors are important among the most frequent users of a primary care clinic. Proposals to improve care for frequent users should consider the psychosocial needs of this population.

Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation.

PubMed

Schumacher, Jessica R; Lutz, Barbara J; Hall, Allyson G; Pines, Jesse M; Jones, Andrea L; Hendry, Phyllis; Kalynych, Colleen; Carden, Donna L

2017-06-01

Older, chronically ill patients with limited health literacy are often under-engaged in managing their health and turn to the emergency department (ED) for healthcare needs. We tested the impact of an ED-initiated coaching intervention on patient engagement and follow-up doctor visits in this high-risk population. We also explored patients' care-seeking decisions. We conducted a mixed-methods study including a randomized controlled trial and in-depth interviews in two EDs in northern Florida. Participants were chronically ill older ED patients with limited health literacy and Medicare as a payer source. Patients were assigned to an evidence-based coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitative interviews (n=9) explored patients' reasons for ED use. We assessed average between-group differences in patient engagement over time with the Patient Activation Measure (PAM) tool, using logistic regression and a difference-in-difference approach. Between-group differences in follow-up doctor visits were determined. We analyzed qualitative data using open coding and thematic analysis. PAM scores fell in both groups after the ED visit but fell significantly more in "usual care" (average decline -4.64) than "intervention" participants (average decline -2.77) (β=1.87, p=0.043). There were no between-group differences in doctor visits. Patients described well-informed reasons for ED visits including onset and severity of symptoms, lack of timely provider access, and immediate and comprehensive ED care. The coaching intervention significantly reduced declines in patient engagement observed after usual post-ED care. Patients reported well-informed reasons for ED use and will likely continue to make ED visits unless strategies, such as ED-initiated coaching, are implemented to help vulnerable patients better manage their health and healthcare.

Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation

PubMed Central

Schumacher, Jessica R.; Lutz, Barbara J.; Hall, Allyson G.; Pines, Jesse M.; Jones, Andrea L.; Hendry, Phyllis; Kalynych, Colleen; Carden, Donna L.

2017-01-01

Introduction Older, chronically ill patients with limited health literacy are often under-engaged in managing their health and turn to the emergency department (ED) for healthcare needs. We tested the impact of an ED-initiated coaching intervention on patient engagement and follow-up doctor visits in this high-risk population. We also explored patients’ care-seeking decisions. Methods We conducted a mixed-methods study including a randomized controlled trial and in-depth interviews in two EDs in northern Florida. Participants were chronically ill older ED patients with limited health literacy and Medicare as a payer source. Patients were assigned to an evidence-based coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitative interviews (n=9) explored patients’ reasons for ED use. We assessed average between-group differences in patient engagement over time with the Patient Activation Measure (PAM) tool, using logistic regression and a difference-in-difference approach. Between-group differences in follow-up doctor visits were determined. We analyzed qualitative data using open coding and thematic analysis. Results PAM scores fell in both groups after the ED visit but fell significantly more in “usual care” (average decline −4.64) than “intervention” participants (average decline −2.77) (β=1.87, p=0.043). There were no between-group differences in doctor visits. Patients described well-informed reasons for ED visits including onset and severity of symptoms, lack of timely provider access, and immediate and comprehensive ED care. Conclusion The coaching intervention significantly reduced declines in patient engagement observed after usual post-ED care. Patients reported well-informed reasons for ED use and will likely continue to make ED visits unless strategies, such as ED-initiated coaching, are implemented to help vulnerable patients better manage their health and healthcare. PMID:28611897

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

ERIC Educational Resources Information Center

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

2011-01-01

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

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

Treesearch

R. Geoffrey Lacher; Matthew T.J. Brownlee

2012-01-01

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

Injuries to rescue workers following the Oklahoma City bombing.

PubMed

Dellinger, A M; Waxweiler, R J; Mallonee, S

1997-06-01

The objective of this study was to identify and describe physical injuries to rescue workers in the aftermath of the Oklahoma City bombing. Data were obtained from medical records from 16 hospital emergency departments and specialty clinics in the Oklahoma City area, and reported visits to medical providers at the bombing site. Participants were rescue personnel from the Oklahoma City Fire Department, the mutual aid fire stations in the Oklahoma City area, the Federal Emergency Management Agency's Urban Search and Rescue teams, and military personnel stationed near Oklahoma City. All participants were involved in the rescue and recovery operation. The two main outcome measures were (1) the number, types, and rates of injuries; and (2) comparisons of case-finding methods, including medical chart review and telephone interview. The most common injuries were strains and sprains (21.4%), foreign bodies in eyes (14.5%), and laceration/crush/puncture wounds (18.4%). Of the four case-finding mechanisms, telephone interviews following the event identified the largest number of cases (84.5%). Most injuries were minor; some injuries such as chemical burns were preventable. The potential utility of other data collection mechanisms is considered.

Comparison of methods used for estimating pharmacist counseling behaviors.

PubMed

Schommer, J C; Sullivan, D L; Wiederholt, J B

1994-01-01

To compare the rates reported for provision of types of information conveyed by pharmacists among studies for which different methods of estimation were used and different dispensing situations were studied. Empiric studies conducted in the US, reported from 1982 through 1992, were selected from International Pharmaceutical Abstracts, MEDLINE, and noncomputerized sources. Empiric studies were selected for review if they reported the provision of at least three types of counseling information. Four components of methods used for estimating pharmacist counseling behaviors were extracted and summarized in a table: (1) sample type and area, (2) sampling unit, (3) sample size, and (4) data collection method. In addition, situations that were investigated in each study were compiled. Twelve studies met our inclusion criteria. Patients were interviewed via telephone in four studies and were surveyed via mail in two studies. Pharmacists were interviewed via telephone in one study and surveyed via mail in two studies. For three studies, researchers visited pharmacy sites for data collection using the shopper method or observation method. Studies with similar methods and situations provided similar results. Data collected by using patient surveys, pharmacist surveys, and observation methods can provide useful estimations of pharmacist counseling behaviors if researchers measure counseling for specific, well-defined dispensing situations.

Chelyabinsk meteoroid entry and airburst damage

NASA Astrophysics Data System (ADS)

Popova, O.; Jenniskens, P.; Shuvalov, V.; Emel'yanenko, V.; Rybnov, Y.; Kharlamov, V.; Kartashova, A.; Biryukov, E.; Khaibrakhmanov, S.; Glazachev, D.; Trubetskaya, I.

2014-07-01

A field study of the Chelyabinsk Airburst was conducted in the weeks following the event on February 15, 2013. To measure the impact energy, the extent of the glass damage was mapped by visiting over 50 villages in the area. To determine how that energy was deposited in the atmosphere, the most suitable dash-cam and video security camera footage was calibrated by taking star background images at the sites where video was taken. Shadow obstacles in videos taken at Chelyabinsk and Chebarkul were calibrated. To measure the nature of the damaging shockwave, arrival times were measured from the footage of 34 traffic cameras, data saved on a single timed server. To measure the impact of the shockwave, some 150 eyewitnesses were interviewed to ask about their personal experiences, smells, sense of heat, sunburn, etc. Meteorite find locations, shape, and size were documented by interviewing the finders and photographing the collections. Some of these meteorites were analyzed in a consortium study to determine what material properties contributed to the manner in which the meteoroid broke in the atmosphere. The results paint the first detailed picture of an asteroid impact airburst over a populated area. This information may help better prepare for future impact hazard mitigation scenarios.

'I am stronger, I'm no longer afraid…', an evaluation of a home-visiting mentor mother support programme for abused women in primary care.

PubMed

Prosman, Gert-Jan; Lo Fo Wong, Sylvie H; Römkens, Renée; Lagro-Janssen, Antoine L M

2014-12-01

We aimed to investigate which factors make a mentor mother support programme for abused women successful. We used semi-structured interviews with abused women and focus group discussions with the mentor mothers to evaluate their experiences and needs within a mentor support programme (MeMoSA). Fourteen abused women were interviewed 6 months after the support programme ended. Mentor mothers participated in two focus group discussions. Abused women emphasised that nonjudgmental listening, equivalence, involvement and bonding are important factors for successful support. Mentor mothers described that empathy, availability, persistence and advocacy fitted the needs of women best to empower them and help them to cope with their violent situation at home. A safe place to meet each other was also an important factor. A good relationship, tailored support provided by home visiting, advocacy and safety are required to effectively help abused women. MeMoSA, a home-visiting support programme, is a promising valuable new support programme in primary care for abused women. © 2013 Nordic College of Caring Science.

Improving Sexual Risk Communication With Adolescents Using Event History Calendars

PubMed Central

Martyn, Kristy K.; Darling-Fisher, Cynthia; Pardee, Michelle; Ronis, David L.; Felicetti, Irene L.; Saftner, Melissa A.

2012-01-01

This study was conducted to explore the effects of an event history calendar (EHC) approach on adolescent sexual risk communication and sexual activity. Adolescent school-linked health clinic patients (n = 30) who reported sexual activity self-administered the EHC that was used by nurse practitioners (NPs; n = 2) during a clinic visit. Immediately pre- and post-visit, and at 1 and 3 months, adolescents reported sexual risk behaviors and perceptions about EHC communication on questionnaires and by interview. NPs reported their perceptions of EHCs by questionnaire after the visit and poststudy interview. The EHC approach facilitated communication and adolescent awareness of their risk behaviors. Scores increased on Amount of Communication, t(29) = 8.174, p < .001; Satisfaction with Communication, t(29) = 3.112, p = .004; Client Involvement in Decision Making, t(29) = 3.901, p = .001, and Client Satisfaction with Interpersonal Style, t(29) = 3.763, p = .001. Adolescents reported decreased sexual intercourse at 1 month, p = .031. School nurses could use the EHC approach to facilitate adolescent communication and tailoring of interventions. PMID:22071717

Transfer of knowledge in international cooperation: the Farmanguinhos - SMM case.

PubMed

Silva, Samuel Araujo Gomes da; Duarte, Roberto Gonzalez; Castro, José Márcio de

2017-01-01

To analyze the influence of four mechanisms of knowledge transfer (training, technical visits, expatriation, and standard operating procedures) on the different dimensions (potential and realized) of absorptive capacity in international technical cooperation. We examine the case of implementation of the Sociedade Moçambicana de Medicamentos. Data have been collected using semi-structured interviews (applied to 21 professionals of the Sociedade Moçambicana de Medicamentos, Farmanguinhos, FIOCRUZ, and Itamaraty) and official documents. The data of the interviews have been submitted to content analysis, using the software NVivo. Training and technical visits directly influenced the acquisition and, partly, the assimilation of knowledge. Expatriation contributed with the transformation of this knowledge from the development and refinement of operational routines. Finally, the definition of standard operating procedures allowed the Mozambican technicians to be the actors of the transformation of the knowledge previously acquired and assimilated and, at the same time, it laid the foundations for a future exploration of the knowledge. Training and technical visits mainly influence the potential absorptive capacity, while expatriation and standard operating procedures most directly affect the realized absorptive capacity.

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

PubMed

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

2018-01-01

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

Emergency contraception supply in Australian pharmacies after the introduction of ulipristal acetate: a mystery shopping mixed-methods study.

PubMed

Collins, Jack Charles; Schneider, Carl Richard; Moles, Rebekah Jane

2018-05-09

To explore the supply of emergency contraception (EC) from Australian community pharmacies after the introduction of ulipristal acetate (UPA) and to explore pharmacists' knowledge, decision-making, attitudes and beliefs surrounding supplying EC. A mixed-methods approach of mystery shopping with structured interview was employed. From August to November 2017, 20 pharmacy students mystery-shopped 10 community pharmacies in metropolitan Sydney, Australia, requesting "the morning after pill." Each pharmacy was visited five times with varying scenarios. Structured interviews were conducted immediately postvisit. Visit data were analyzed descriptively and comparatively. Interviews were transcribed verbatim and categorically analyzed. Of 50 planned visits, 43 were analyzed. EC was supplied in 38 requests by pharmacists (54% male). Levonorgestrel (LNG) was more frequently supplied than UPA (74% vs. 26%). UPA was only supplied when intercourse occurred >72 h prior. Directions for use were provided in 35 supplies. No difference in questioning or counseling was found based on sex of requester. Female pharmacists provided more counseling points (MED=4 [IQR=4-5] vs. MED=3 [IQR=0-4]; p<.01). Two pharmacists asked all guideline questions, and no pharmacist provided all guideline counseling points. Interviews elicited supply guidelines, regulatory and clinical knowledge, financial considerations, privacy and stock availability as factors influencing EC supply. EC was supplied in accordance with local legislation in all instances, with the majority supplied within the licensed timeframe for each EC formulation. LNG was supplied more frequently than UPA. UPA was only supplied in the 72-120-h timeframe. Clinical and regulatory knowledge, availability and cost to consumer were identified as factors influencing supply. This study found that despite the introduction of ulipristal acetate to the Australian market, it is not frequently supplied. Interviews identified the need for continuing professional development regarding pharmacist clinical and regulatory knowledge. Future guideline development should consider utility and user needs to optimize the implementation of guidelines. Copyright © 2018. Published by Elsevier Inc.

Predicting Patients' Expectations of Hospital Chaplains: A Multisite Survey

PubMed Central

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

2010-01-01

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

STS-130 Nationals Park Visit

NASA Image and Video Library

2010-04-20

NASA STS-130 Pilot Terry Virts, right, is interviewed by Mid-Atlantic Sports Network (MASN) reporter Debbie Taylor at Nationals Park Tuesday, April 20, 2010, in Washington. Photo Credit: (NASA/Carla Cioffi)

STS-130 Nationals Park Visit

NASA Image and Video Library

2010-04-20

NASA STS-130 Pilot Terry Virts, center, is interviewed by Washington Nationals radio broadcasters Charlie Slowes, right, and David Jageler on Tuesday, April 20, 2010, in Washington. Photo Credit: (NASA/Carla Cioffi)

ACASI and face-to-face interviews yield inconsistent estimates of domestic violence among women in India: The Samata Health Study 2005-2009.

PubMed

Rathod, Sujit D; Minnis, Alexandra M; Subbiah, Kalyani; Krishnan, Suneeta

2011-08-01

Audio computer-assisted self-interviews (ACASI) are increasingly used in health research to improve the accuracy of data on sensitive behaviors. However, evidence is limited on its use among low-income populations in countries like India and for measurement of sensitive issues such as domestic violence. We compared reports of domestic violence and three less sensitive behaviors related to household decision making and spousal communication in ACASI and face-to-face interviews (FTFI) among 464 young married women enrolled in a longitudinal study of gender-based power and adverse health outcomes in low-income communities in Bangalore, India. We used a test-retest design. At the 12-month study visit, we elicited responses from each participant through FTFI first, followed by ACASI. At the 24-month visit, we reversed the order, implementing ACASI first, followed by FTFI. Univariable log-linear regression models and kappa statistics were used to examine ACASI's effects on self-reports. Regression results showed significantly lower reporting in ACASI relative to FTFI at both visits, including for domestic violence (12-month risk ratio [RR] = 0.61, 95% CI = 0.52, 0.73; 24-month RR = 0.74, 95% CI = 0.62, 0.89). Response agreement between interview modes, calculated by kappa scores, was universally low, though highest for domestic violence (12-month κ = 0.45; 24-month κ = 0.48). Older age and greater educational attainment appeared associated with higher response agreement. Greater reporting in FTFI may be due to social desirability bias for the less sensitive questions and perceptions of therapeutic benefit for domestic violence. These results cast doubt on the appropriateness of using ACASI for measurement of sensitive behaviors in India.

Telemedicine in Neonatal Home Care: Identifying Parental Needs Through Participatory Design.

PubMed

Garne, Kristina; Brødsgaard, Anne; Zachariassen, Gitte; Clemensen, Jane

2016-07-08

For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. To identify parental needs when wanting to provide neonatal home care supported by telemedicine. The study used participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care with telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively. Three overall themes were identified: being a family, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a "bell cord" to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition. Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when combined with nursing guidance. Parents did not request hands-on support for infant care, but instead expressed a need for communication and guidance, which could be met using telemedicine.

Cross-sectional survey of treatment practices for urethritis at pharmacies, private clinics and government health facilities in coastal Kenya: many missed opportunities for HIV prevention.

PubMed

Mugo, Peter M; Duncan, Sarah; Mwaniki, Samuel W; Thiong'o, Alexander N; Gichuru, Evanson; Okuku, Haile Selassie; van der Elst, Elise M; Smith, Adrian D; Graham, Susan M; Sanders, Eduard J

2013-11-01

While bacterial sexually transmitted infections (STIs) are important cofactors for HIV transmission, STI control has received little attention in recent years. The aim of this study was to assess STI treatment and HIV testing referral practices among health providers in Kenya. In 2011 we assessed quality of case management for male urethritis at pharmacies, private clinics and government health facilities in coastal Kenya using simulated visits at pharmacies and interviews at pharmacies and health facilities. Quality was assessed using Ministry of Health guidelines. Twenty (77%) of 26 pharmacies, 20 (91%) of 22 private clinics and all four government facilities in the study area took part. The median (IQR) number of adult urethritis cases per week was 5 (2-10) at pharmacies, 3 (1-3) at private clinics and 5 (2-17) at government facilities. During simulated visits, 10% of pharmacies prescribed recommended antibiotics at recommended dosages and durations and, during interviews, 28% of pharmacies and 27% of health facilities prescribed recommended antibiotics at recommended dosages and durations. Most regimens were quinolone-based. HIV testing was recommended during 10% of simulated visits, 20% of pharmacy interviews and 25% of health facility interviews. In an area of high STI burden, most men with urethritis seek care at pharmacies and private clinics. Most providers do not comply with national guidelines and very few recommend HIV testing. In order to reduce the STI burden and mitigate HIV transmission, there is an urgent need for innovative dissemination of up-to-date guidelines and inclusion of all health providers in HIV/STI programmes.

Disorientating, fun or meaningful? Disadvantaged families' experiences of a science museum visit

NASA Astrophysics Data System (ADS)

Archer, Louise; Dawson, Emily; Seakins, Amy; Wong, Billy

2016-12-01

It is widely agreed that there is a need to increase and widen science participation. Informal science learning environments (ISLEs), such as science museums, may provide valuable spaces within which to engage visitors—yet the visitor profile of science museums remains narrow. This paper seeks to understand the experiences of socially disadvantaged families within such spaces. Using a Bourdieusian analytic lens, we analyse qualitative data from a small study conducted with ten parents and ten children from an urban school who visited a large science museum. Data includes pre- and post-interviews, audio recordings and visit fieldnotes. We characterised families' experiences as falling into three discourses, as `disorientating', `fun' or `meaningful' visits. Analysis identifies how the families' experiences, and the likelihood of deriving science learning from the visit, were shaped through interactions of habitus and capital. Implications for improving equity and inclusion within ISLEs are discussed.

Recent trends in dental visits and private dental insurance, 1989 and 1999.

PubMed

Wall, Thomas P; Brown, L Jackson

2003-05-01

This article describes recent trends in dental visits and private dental insurance in the United States. This study is based on the analyses of data regarding dental visits and private dental insurance among the population 2 years of age or older from the 1989 and 1999 National Health Interview Surveys. Overall, the percentage of the population with a dental visit rose from 57.2 percent in 1989 to 64.1 percent in 1999, while the percentage with private dental insurance fell from 40.5 percent to 35.2 percent. Although a higher percentage of people with private dental insurance reported having a dental visit than did those without private dental insurance in both years, the increase from 1989 to 1999 in the percentage of those with a visit was larger among the uninsured. If this trend persists, a smaller portion of practicing dentist's clientele will be insured. This may affect demand for services, as well as front office operations.

A New Graduate-Level Seminar to Prepare Students for the Next Step in Their Careers

ERIC Educational Resources Information Center

Fleming, Kelly L.; Matthaei, James; Pfaendtner, Jim

2015-01-01

Many new Ph.D.s are not prepared for a competitive interview process in seeking a first job. The University of Washington (UW) designed the Distinguished Young Scholars Seminar (DYSS) to rectify this problem with three goals: simulate a visit associated with many interviews and a one-hour seminar; make UW graduate students aware of where they fit…

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

PubMed

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

2017-12-01

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

Acceptance of a pre-visit intervention to engage teens in pediatric asthma visits.

PubMed

Sleath, Betsy; Carpenter, Delesha M; Davis, Scott A; Watson, Claire Hayes; Lee, Charles; Loughlin, Ceila E; Garcia, Nacire; Etheridge, Dana; Rivera-Duchesne, Laura; Reuland, Daniel S; Batey, Karolyne; Duchesne, Cristina; Tudor, Gail

2017-11-01

The objectives of this study were to: (a) describe teen feedback on an asthma question prompt list/video intervention designed to motivate teens to be more engaged during visits and (b) examine teen demographics associated with teen acceptance of the intervention. Two hundred and fifty-nine teens ages 11 to 17 with persistent asthma were enrolled into a randomized, controlled trial and assigned to either a standard care or an intervention group where they watched an educational video with their parents and received a prompt list to complete before visits. Teens were interviewed after visits. Of the 185 teens randomized to the intervention group: 93% said teens should complete the prompt lists before visits; 95% recommended teens should watch the video before visits; teens with moderate/severe persistent asthma were significantly more likely to find the prompt list useful; non-White teens were significantly more likely to find the prompt list and video more useful. Teens exposed to the question prompt list/video had very positive feedback about the intervention. Providers/practices should consider having teens complete question prompt lists during pre-visit wait time for use during visits and watch the video with their parents before visits. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed

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

2007-08-01

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

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

PubMed

Slagle, Malinda W; Hendrix, Stephen D

2009-10-01

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

Recruitment and accrual of women in a placebo-controlled clinical pilot study on manual therapy.

PubMed

Cambron, Jerrilyn A; Hawk, Cheryl; Evans, Roni; Long, Cynthia R

2004-06-01

To investigate the accrual rates and recruitment processes among 3 Midwestern sites during a pilot study on manual therapy for chronic pelvic pain. Multisite pilot study for a randomized, placebo-controlled clinical trial. Three chiropractic institutions in or near major metropolitan cities in the Midwestern United States. Thirty-nine women aged 18 to 45 with chronic pelvic pain of at least 6 months duration, diagnosed by a board certified gynecologist. The method of recruitment was collected for each individual who responded to an advertisement and completed an interviewer-administered telephone screen. Participants who were willing and eligible after 3 baseline visits were entered into a randomized clinical trial. The number of responses and accrual rates were determined for the overall study, each of the 3 treatment sites, and each of the 5 recruitment efforts. In this study, 355 women were screened over the telephone and 39 were randomized, making the rate of randomization approximately 10%. The most effective recruitment methods leading to randomization were direct mail (38%) and radio advertisements (34%). However, success of the recruitment process differed by site. Based on the accrual of this multisite pilot study, a full-scale trial would not be feasible using this study's parameters. However, useful information was gained on recruitment effectiveness, eligibility criteria, and screening protocols among the 3 metropolitan sites.

Treatment compliance and outcome at an urban primary care clinic.

PubMed

Axton, J H; Zwambila, L G

1982-06-01

An attempt was made to determine treatment compliance and outcome at an urban promary care clinic in Zimbabwe. A research nursing sister sat in on an urban primary care clinic 1 day a week for 10 consecutive weeks recording the address, presenting compliant, physical findings, and treatment ordered, as defined by the clinic sister in attendance, of the first 10 consecutive cases seen on the day of the visit. Approximately 1 week later, she visited the home address and interviewed the mother. It is only possible to give medication for 24 hours at a time in the urban clinics, which entails a daily visit by the mother and child, even for oral medicines. At a child's 1st visit to the clinic, the mother is given a treatment card on which daily attendance, with medication given, ir recorded. Compliance was assessed by simply inspecting the card. 100 primary care consultations were recorded, but 1 record was lost. 99 visits to home addresses were undertaken, and in 83 visits contact was made with mother and child. (( of the 83 children were regarded by their mothers as better and no longer in need of treatment. 79 of the 83 mothers interviewed were satisfied or very satisfied with the treatment provided at the clinic. At least 1 medicine was prescribed to every child at his/her initial clinic visit and in some children up to 4. 86 children recieved an antibiotic or sulphas, or both. The majority of children seen were suffering from upper respiratory tract infections (50) or gastroenteritis, the majority of which were probably viral illnesses. The main factors for the good compliance among the population studied include: short distance from home to clinic; initial consultation took place in the mothers' own language; and the large number of intramuscular injections ordered as part of the treatment. Further education in the management of simple childhood conditions, and particularly in the use of antobiotics, needs to be given to nursing sisters conducting primary care clinics.

Influences on visit retention in clinical trials: Insights from qualitative research during the VOICE trial in Johannesburg, South Africa

PubMed Central

2014-01-01

Background Although significant progress has been made in clinical trials of women-controlled methods of HIV prevention such as microbicides and Pre-exposure Prophylaxis (PrEP), low adherence to experimental study products remains a major obstacle to being able to establish their efficacy in preventing HIV infection. One factor that influences adherence is the ability of trial participants to attend regular clinic visits at which trial products are dispensed, adherence counseling is administered, and participant safety is monitored. We conducted a qualitative study of the social contextual factors that influenced adherence in the VOICE (MTN-003) trial in Johannesburg, South Africa, focusing on study participation in general, and study visits in particular. Methods The research used qualitative methodologies, including in-depth interviews (IDI), serial ethnographic interviews (EI), and focus group discussions (FGD) among a random sub-sample of 102 female trial participants, 18 to 40 years of age. A socio-ecological framework that explored those factors that shaped trial participation and adherence to study products, guided the analysis. Key codes were developed to standardize subsequent coding and a node search was used to identify texts relating to obstacles to visit adherence. Our analysis includes coded transcripts from seven FGD (N = 40), 41 IDI, and 64 serial EI (N = 21 women). Results Women’s kinship, social, and economic roles shaped their ability to participate in the clinical trial. Although participants expressed strong commitments to attend study visits, clinic visit schedules and lengthy waiting times interfered with their multiple obligations as care givers, wage earners, housekeepers, and students. Conclusions The research findings highlight the importance of the social context in shaping participation in HIV prevention trials, beyond focusing solely on individual characteristics. This points to the need to focus interventions to improve visit attendance by promoting a culture of active and engaged participation. PMID:25065834

Influences on visit retention in clinical trials: insights from qualitative research during the VOICE trial in Johannesburg, South Africa.

PubMed

Magazi, Busisiwe; Stadler, Jonathan; Delany-Moretlwe, Sinead; Montgomery, Elizabeth; Mathebula, Florence; Hartmann, Miriam; van der Straten, Ariane

2014-07-28

Although significant progress has been made in clinical trials of women-controlled methods of HIV prevention such as microbicides and Pre-exposure Prophylaxis (PrEP), low adherence to experimental study products remains a major obstacle to being able to establish their efficacy in preventing HIV infection. One factor that influences adherence is the ability of trial participants to attend regular clinic visits at which trial products are dispensed, adherence counseling is administered, and participant safety is monitored. We conducted a qualitative study of the social contextual factors that influenced adherence in the VOICE (MTN-003) trial in Johannesburg, South Africa, focusing on study participation in general, and study visits in particular. The research used qualitative methodologies, including in-depth interviews (IDI), serial ethnographic interviews (EI), and focus group discussions (FGD) among a random sub-sample of 102 female trial participants, 18 to 40 years of age. A socio-ecological framework that explored those factors that shaped trial participation and adherence to study products, guided the analysis. Key codes were developed to standardize subsequent coding and a node search was used to identify texts relating to obstacles to visit adherence. Our analysis includes coded transcripts from seven FGD (N = 40), 41 IDI, and 64 serial EI (N = 21 women). Women's kinship, social, and economic roles shaped their ability to participate in the clinical trial. Although participants expressed strong commitments to attend study visits, clinic visit schedules and lengthy waiting times interfered with their multiple obligations as care givers, wage earners, housekeepers, and students. The research findings highlight the importance of the social context in shaping participation in HIV prevention trials, beyond focusing solely on individual characteristics. This points to the need to focus interventions to improve visit attendance by promoting a culture of active and engaged participation.

Living on the edge of asthma: A grounded theory exploration.

PubMed

Shaw, Michele R; Oneal, Gail

2014-10-01

Most asthma-related emergency department (ED) visits and hospitalizations for asthma are preventable. Our purpose was to develop a grounded theory to guide interventions to reduce unnecessary hospitalizations and ED visits. Grounded theory inquiry guided interviews of 20 participants, including 13 parents and 7 children. Living on the edge of asthma was the emergent theory. Categories included: balancing, losing control, seeking control, and transforming. The theory provides the means for nurses to understand the dynamic process that families undergo in trying to prevent and then deal with and learn from an acute asthma attack requiring hospitalization or an ED visit. © 2014, Wiley Periodicals, Inc.

Tobacco point-of-sale displays in England: a snapshot survey of current practices.

PubMed

Rooke, Catriona; Cheeseman, Hazel; Dockrell, Martin; Millward, Deborah; Sandford, Amanda

2010-08-01

Tobacco displays at the point of sale (PoS) are an important means for the tobacco industry to communicate with consumers. With regulations prohibiting PoS displays recently having come into force in Ireland, passed into law in England, Wales and Northern Ireland and some Australian states, and being considered in New Zealand, Finland and Brazil, this is an increasingly important issue. This study explores the nature of displays, the extent to which they are tobacco industry funded, and the relation between the tobacco companies and retailers. Three areas were chosen to gain a snapshot of PoS displays in England. Over 100 retailers were visited, with interviews taking place on site. Information was gathered on the type and size of tobacco display, who was paying for the display, requirements and incentives, and visits by industry representatives. The majority of retailers had gantries provided by tobacco companies. A minority of these were fitted with automated dispensers called retail vending machines. Attractive lighting and colour were often used to highlight particular products. Most retailers were being visited by industry representatives who checked displays. Some retailers also reported incentives offered to them for displaying products. The results suggest that the tobacco industry presence and control in the retail environment is significant. Tobacco companies overwhelmingly provided tobacco gantries in the shops surveyed and influenced displays through a combination of requirements and incentives. The extensive involvement of tobacco companies in providing and monitoring retail displays suggests the importance of implementing policies to end this form of advertising.

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

ERIC Educational Resources Information Center

US Department of Education, 2010

2010-01-01

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

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

Treesearch

Rex Turner; Wilbur LaPage

2002-01-01

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

Randomized evaluation of a web based interview process for urology resident selection.

PubMed

Shah, Satyan K; Arora, Sanjeev; Skipper, Betty; Kalishman, Summers; Timm, T Craig; Smith, Anthony Y

2012-04-01

We determined whether a web based interview process for resident selection could effectively replace the traditional on-site interview. For the 2010 to 2011 match cycle, applicants to the University of New Mexico urology residency program were randomized to participate in a web based interview process via Skype or a traditional on-site interview process. Both methods included interviews with the faculty, a tour of facilities and the opportunity to ask current residents any questions. To maintain fairness the applicants were then reinterviewed via the opposite process several weeks later. We assessed comparative effectiveness, cost, convenience and satisfaction using anonymous surveys largely scored on a 5-point Likert scale. Of 39 total participants (33 applicants and 6 faculty) 95% completed the surveys. The web based interview was less costly to applicants (mean $171 vs $364, p=0.05) and required less time away from school (10% missing 1 or more days vs 30%, p=0.04) compared to traditional on-site interview. However, applicants perceived the web based interview process as less effective than traditional on-site interview, with a mean 6-item summative effectiveness score of 21.3 vs 25.6 (p=0.003). Applicants and faculty favored continuing the web based interview process in the future as an adjunct to on-site interviews. Residency interviews can be successfully conducted via the Internet. The web based interview process reduced costs and improved convenience. The findings of this study support the use of videoconferencing as an adjunct to traditional interview methods rather than as a replacement. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Elementary school children's science learning from school field trips

NASA Astrophysics Data System (ADS)

Glick, Marilyn Petty

This research examines the impact of classroom anchoring activities on elementary school students' science learning from a school field trip. Although there is prior research demonstrating that students can learn science from school field trips, most of this research is descriptive in nature and does not examine the conditions that enhance or facilitate such learning. The current study draws upon research in psychology and education to create an intervention that is designed to enhance what students learn from school science field trips. The intervention comprises of a set of "anchoring" activities that include: (1) Orientation to context, (2) Discussion to activate prior knowledge and generate questions, (3) Use of field notebooks during the field trip to record observations and answer questions generated prior to field trip, (4) Post-visit discussion of what was learned. The effects of the intervention are examined by comparing two groups of students: an intervention group which receives anchoring classroom activities related to their field trip and an equivalent control group which visits the same field trip site for the same duration but does not receive any anchoring classroom activities. Learning of target concepts in both groups was compared using objective pre and posttests. Additionally, a subset of students in each group were interviewed to obtain more detailed descriptive data on what children learned through their field trip.

Early childhood experiences, cultural beliefs, and oral health of Mexican American women.

PubMed

Miltiades, Helen B

2013-01-01

This qualitative article examines how financial resources, cultural beliefs, and early childhood experiences affect perceptions of oral health and dental utilization of middle-aged and older Mexican American women. Fourteen in-depth qualitative interviews were conducted. The women's ages range from 49 to 87 years. Most had not visited the dentist in more than 2 years. Most women's early childhood experiences did not include dental visits or dental instruction. Some believed tooth loss was a normal aging process. Misconceptions regarding preventive care, the belief that dental visits were only necessary when experiencing pain, and finances were the primary reasons for not visiting the dentist. The results lend insight into the oral health, self-care practices, and dental utilization of middle-aged and older immigrant Mexican American women.

Relationship work in an early childhood home visiting program.

PubMed

Heaman, Maureen; Chalmers, Karen; Woodgate, Roberta; Brown, Judy

2007-08-01

A significant component of the work of public health nurses and paraprofessional home visitors who provide home visits to families with young children involves establishing relationships to effectively deliver the visiting program. The purpose of this qualitative and descriptive study was to describe the relationships among participants in a home visiting program in one regional health authority in the Canadian province of Manitoba. Interviews were carried out with 24 public health nurses, 14 home visitors, and 20 parents. The findings related to establishing, maintaining, and terminating relationships as well as factors influencing relationship work are described. Public health nurses and home visitors put significant effort into the work of establishing relationships with each other and their clients and require adequate training, sufficient human resources, and support from the program's administration to sustain these relationships.

Improving healthcare systems' disclosures of large-scale adverse events: a Department of Veterans Affairs leadership, policymaker, research and stakeholder partnership.

PubMed

Elwy, A Rani; Bokhour, Barbara G; Maguire, Elizabeth M; Wagner, Todd H; Asch, Steven M; Gifford, Allen L; Gallagher, Thomas H; Durfee, Janet M; Martinello, Richard A; Schiffner, Susan; Jesse, Robert L

2014-12-01

The Department of Veterans Affairs (VA) mandates disclosure of large-scale adverse events to patients, even if risk of harm is not clearly present. Concerns about past disclosures warranted further examination of the impact of this policy. Through a collaborative partnership between VA leaders, policymakers, researchers and stakeholders, the objective was to empirically identify critical aspects of disclosure processes as a first step towards improving future disclosures. Semi-structured interviews were conducted with participants at nine VA facilities where recent disclosures took place. Ninety-seven stakeholders participated in the interviews: 38 employees, 28 leaders (from facilities, regions and national offices), 27 Veteran patients and family members, and four congressional staff members. Facility and regional leaders were interviewed by telephone, followed by a two-day site visit where employees, patients and family members were interviewed face-to-face. National leaders and congressional staff also completed telephone interviews. Interviews were analyzed using rapid qualitative assessment processes. Themes were mapped to the stages of the Crisis and Emergency Risk Communication model: pre-crisis, initial event, maintenance, resolution and evaluation. Many areas for improvement during disclosure were identified, such as preparing facilities better (pre-crisis), creating rapid communications, modifying disclosure language, addressing perceptions of harm, reducing complexity, and seeking assistance from others (initial event), managing communication with other stakeholders (maintenance), minimizing effects on staff and improving trust (resolution), and addressing facilities' needs (evaluation). Through the partnership, five recommendations to improve disclosures during each stage of communication have been widely disseminated throughout the VA using non-academic strategies. Some improvements have been made; other recommendations will be addressed through implementation of a large-scale adverse event disclosure toolkit. These toolkit strategies will enable leaders to provide timely and transparent information to patients and families, while reducing the burden on employees and the healthcare system during these events.

Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 574: Neptune, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

2011-08-31

This Streamlined Approach for Environmental Restoration (SAFER) Plan identifies the activities required for closure of Corrective Action Unit (CAU) 574, Neptune. CAU 574 is included in the Federal Facility Agreement and Consent Order (FFACO) (1996 [as amended March 2010]) and consists of the following two Corrective Action Sites (CASs) located in Area 12 of the Nevada National Security Site: (1) CAS 12-23-10, U12c.03 Crater (Neptune); (2) CAS 12-45-01, U12e.05 Crater (Blanca). This plan provides the methodology for the field activities that will be performed to gather the necessary information for closure of the two CASs. There is sufficient information andmore » process knowledge regarding the expected nature and extent of potential contaminants to recommend closure of CAU 574 using the SAFER process. Based on historical documentation, personnel interviews, site process knowledge, site visits, photographs, field screening, analytical results, the results of the data quality objective (DQO) process (Section 3.0), and an evaluation of corrective action alternatives (Appendix B), closure in place with administrative controls is the expected closure strategy for CAU 574. Additional information will be obtained by conducting a field investigation to verify and support the expected closure strategy and provide a defensible recommendation that no further corrective action is necessary. This will be presented in a Closure Report that will be prepared and submitted to the Nevada Division of Environmental Protection (NDEP) for review and approval.« less

Health plan competition in local markets.

PubMed Central

Grossman, J M

2000-01-01

OBJECTIVE: To examine the structure of local health insurance markets and the strategies health plans were using to respond to competitive pressures in local markets in 1996/1997. DATA SOURCES/STUDY SETTING: Community Tracking Study site visits conducted between May 1996 and April 1997 in 12 U.S. markets selected to be nationally representative. STUDY DESIGN: In each site, 36 to 60 interviews on local health system change were conducted with healthcare industry informants representing health plans, providers, and purchasers. DATA COLLECTION/EXTRACTION METHOD: Relevant data for this article were abstracted from standardized protocols administered to multiple respondents in each site. PRINCIPAL FINDINGS: Although the competitive threat from national plans was pervasive, local plans in most sites continued to retain strong, often dominant, positions in historically concentrated markets. In all sites, in response to purchaser pressures for stable premiums and provider choice, and the threat of entry and to plans were using three strategies to increase market share and market power: (1) consolidation/geographic expansion, (2) price competition, and (3) product line/segment diversification that focused on broad networks and open-access products. In most markets, in response to the demand for provider choice, the trend was away from ownership and exclusive arrangements with providers. CONCLUSIONS: Although local plans were moving to become full-service regional players, there was uncertainty about the abilities of all plans to sustain growth strategies at the expense of margins and organizational stability, and to effectively manage care with broad networks. PMID:10778822

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

PubMed Central

2016-01-01

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

Use of mobile phone consultations during home visits by Community Health Workers for maternal and newborn care: community experiences from Masindi and Kiryandongo districts, Uganda.

PubMed

Mangwi Ayiasi, Richard; Atuyambe, Lynn Muhimbuura; Kiguli, Juliet; Garimoi Orach, Christopher; Kolsteren, Patrick; Criel, Bart

2015-06-18

Home visits by Community Health Workers [In Uganda Community Health Workers are given the collective term of Village Health Teams (VHTs). Hereafter referred to as VHTs] is recommended to improve maternal and newborn care. We investigated perceived maternal and newborn benefits of home visits made by VHTs, combined with mobile phone consultations with professional health workers for advice. A qualitative study was conducted in Masindi and Kiryandongo districts, Uganda, in December-2013 to March-2014. Study participants were drawn from the intervention arm of a randomised community-intervention trial. In-depth interviews were conducted with 20 prenatal and 16 postnatal women who were visited by VHTs; 5 group discussions and 16 key informant interviews were held with VHTs and 10 Key Informant Interviews with professional health workers. Data were analysed using latent content analysis techniques. Majority women and VHTs contend that the intervention improved access to maternal and newborn information; reduced costs of accessing care and facilitated referral. Women, VHTs and professional health workers acknowledged that the intervention induced attitudinal change among women and VHTs towards adapting recommended maternal and newborn care practices. Mobile phone consultations between VHTs and professional health workers were considered to reinforce VHT knowledge on maternal newborn care and boosted the social status of VHTs in community. A minority of VHTs perceived the implementation of recommended maternal and newborn care practices as difficult. Some professional health workers did not approve of the transfer of promotional maternal and newborn responsibility to VHTs. For a range of reasons, a number of professional health workers were not always available on phone or at the health centre to address VHT concerns. Results suggest that home visits made by VHTs for maternal and newborn care are reasonably well accepted. Our study highlights potential benefits of combining home visits with phone consultations between VHTs and professional health workers. However, the challenge of attitudinal change among VHTs towards certain strongly culturally-embedded behavioural post-partum practices, resistance from part of the professional health workforce to collaborate with VHTs and the problematic availability of professional health workers are important systemic problems that need to be addressed. Current Controlled Trials NCT02084680. Registered 14 March 2014.

76 FR 2442 - Reports, Forms, and Record Keeping Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-13

... interviews over a period of approximately 26 months. The survey will ask questions about drinking behavior... wave of telephone interviews with residents in 3 program sites and 2 comparison sites not carrying out... will be 1,200 while sample size for the comparisons sites will be 500, totaling 23,000 interviews...

Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study.

PubMed

Hopkins, Jammie M; Glenn, Beth A; Cole, Brian L; McCarthy, William; Yancey, Antronette

2012-06-01

Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations' full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite's intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60-70 worksites in Los Angeles County.

Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study

PubMed Central

Hopkins, Jammie M.; Glenn, Beth A.; Cole, Brian L.; McCarthy, William; Yancey, Antronette

2012-01-01

Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations’ full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite’s intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60–70 worksites in Los Angeles County. PMID:22323279

Smoot Cosmology Group

Science.gov Websites

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

A Qualitative Exploration of Co-location as an Intervention to Strengthen Home Visiting Implementation in Addressing Maternal Child Health.

PubMed

Kellom, Katherine S; Matone, Meredith; Adejare, Aderinola; Barg, Frances K; Rubin, David M; Cronholm, Peter F

2018-06-01

Objectives The aim of this paper is to explore the process and impact of co-locating evidence-based maternal and child service models to inform future implementation efforts. Methods As part of a state-wide evaluation of maternal and child home visiting programs, we conducted semi-structured interviews with administrators and home visitors from home visiting agencies across Pennsylvania. We collected 33 interviews from 4 co-located agencies. We used the Consolidated Framework for Implementation Research (CFIR) to describe the key elements mitigating implementation of multiple home visiting models. Results A primary advantage of co-location described by participants was the ability to increase the agency's base of eligible clients through the implementation of a model with different program eligibility (e.g. income, child age) than the existing agency offering. Model differences related to curriculum (e.g. content or intensity/meeting frequency) enabled programs to more selectively match clients to models. To recruit eligible clients, new models were able to build upon the existing service networks of the initial program. Co-location provided organizational opportunities for shared trainings, enabling administrative efficiencies and collaborative staff learning. Programs implemented strategies to build synergies with complementary model features, for instance using the additional program option to serve waitlisted clients and to transition services after one model is completed. Conclusions for Practice Considerable benefits are experienced when home visiting models co-locate. This research builds on literature encouraging collaboration among community agencies and provides insight on a specific facilitative approach. This implementation strategy informs policy across the social services spectrum and competitive funding contexts.

Spa Goers' Repeated Visits for Health and Wellness and the Influential Factors: An Exploratory Study of the UK Spa Goers.

PubMed

Choi, Myungsuk; Poade, Donna; Sohn, Minsung; Choi, Mankyu

2016-01-01

Dissemination of spa services across the globe and its market saturation drive demand for differentiated communication methods. This study aims to explore the influential factors on spa goers' repeated visits and their practical applications in the health and wellness spa industry. The identified factors were used as the measurement variables to examine the relation with spa goers' repeated visits. The proposed concept was tested by a mixed method combining a self-administered questionnaire and semistructured interview with 54 survey participants and 6 interviewees. It was meaningful to use a sample of the UK spa goers from the southwest region since global spa trends stem from the EU spas, and the United Kingdom is one of the market leaders. The data were analyzed using frequency, percentage, multiple logistic regression analysis, and coding process. The survey findings demonstrated that the most significant influential factor on the repeated spa visits is a memorable experience of which showed 13.7 times higher probability than the reference up-to-date facility. The details of memorable experiences were discovered throughout the interviews that include the rediscovery of self, feeling of connectedness, recharge for positive emotions, self-reward through escapism, and experience of noncommercialized local products and attractions. Therefore, using experiential marketing methods can be effective spa service marketing.

Adolescent Perspectives on Patient-Provider Sexual Health Communication: A Qualitative Study.

PubMed

Hoopes, Andrea J; Benson, Samantha K; Howard, Heather B; Morrison, Diane M; Ko, Linda K; Shafii, Taraneh

2017-10-01

Adolescents in the United States are disproportionately affected by sexually transmitted infections and unintended pregnancy. Adolescent-centered health services may reduce barriers to health care; yet, limited research has focused on adolescents' own perspectives on patient-provider communication during a sexual health visit. Twenty-four adolescents (14-19 years old) seeking care in a public health clinic in Washington State participated in one-on-one qualitative interviews. Interviews explored participants' past experiences with medical providers and their preferences regarding provider characteristics and communication strategies. Interviews revealed that (1) individual patient dynamics and (2) patient-provider interaction dynamics shape the experience during a sexual health visit. Individual patient dynamics included evolving level of maturity, autonomy, and sexual experience. Patient-provider interaction dynamics were shaped by adolescents' perceptions of providers as sources of health information who distribute valued sexual health supplies like contraception and condoms. Participant concerns about provider judgment, power differential, and lack of confidentiality also emerged as important themes. Adolescents demonstrate diverse and evolving needs for sexual health care and interactions with clinicians as they navigate sexual and emotional development.

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

PubMed

Parker, F D; Welch, J B

1991-10-01

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

The End of an Era: What Became of the “Managed Care Revolution” in 2001?

PubMed Central

Lesser, Cara S; Ginsburg, Paul B; Devers, Kelly J

2003-01-01

Objective To describe how the organization and dynamics of health systems changed between 1999 and 2001, in the context of expectations from the mid-1990s when managed care was in ascendance, and assess the implications for consumers and policymakers. Data Sources/Study Setting Data are from the Community Tracking Study site visits to 12 communities that were randomly selected to be nationally representative of metropolitan areas with 200,000 people or more. The Community Tracking Study is an ongoing effort that began in 1996 and is fielded every two years. Study Design Semistructured interviews were conducted with 50–90 stakeholders and observers of the local health care market in each of the 12 communities every two years. Respondents include leaders of local hospitals, health plans, and physician organizations and representatives of major employers, state and local governments, and consumer groups. First round interviews were conducted in 1996–1997 and subsequent rounds of interviews were conducted in 1998–1999 and 2000–2001. A total of 1,690 interviews were conducted between 1996 and 2001. Data Analysis Methods Interview information was stored and coded in qualitative data analysis software. Data were analyzed to identify patterns and themes within and across study sites and conclusions were verified by triangulating responses from different respondent types, examining outliers, searching for disconfirming evidence, and testing rival explanations. Principal Findings Since the mid-1990s, managed care has developed differently than expected in local health care markets nationally. Three key developments shaped health care markets between 1999 and 2001: (1) unprecedented, sustained economic growth that resulted in extremely tight labor markets and made employers highly responsive to employee demands for even fewer restrictions on access to care; (2) health plans increasingly moved away from core strategies in the “managed care toolbox”; and (3) providers gained leverage relative to managed care plans and reverted to more traditional strategies of competing for patients based on services and amenities. Conclusions Changes in local health care markets have contributed to rising costs and created new access problems for consumers. Moreover, the trajectory of change promises to make the goals of cost-control and quality improvement more difficult to achieve in the future. PMID:12650370

Spouse Abuse: The Problem and a Proposal for Military Police Intervention

DTIC Science & Technology

1984-12-01

relation to law enforcement, by visiting 17 police departments9 interviewing police managers , surveying 130 police officers, and interviewing social...about presenting a lot of information, while managing to gain and hold the interest of the audience. Since spouse abuse is such a controversial subject...available for domestic violence victims and batterers. The author was also invited to attend a meeting with the Family * Advocacy Case Management Team

Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers

PubMed Central

Martin-Biggers, Jennifer; Spaccarotella, Kim; Delaney, Colleen; Koenings, Mallory; Alleman, Gayle; Hongu, Nobuko; Worobey, John; Byrd-Bredbenner, Carol

2015-01-01

Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles) with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith’s Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251) and content (n = 261) occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial. PMID:26266419

Children visiting family and friends on adult intensive care units: the nurses' perspective.

PubMed

Clarke, C M

2000-02-01

Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small-scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. It is hoped that the study will act as an initial enquiry to generate themes and further research questions. A qualitative research approach was adopted and in-depth focused interviews used as a method of data collection. The participants of the study were trained nurses working on an adult intensive care unit in a district general hospital in England. A total of 12 individual interviews were conducted which were audiotaped in full and analysed using a method of thematic content analysis. The value of the research is to promote family-centred care within an adult intensive care environment to meet the neglected needs of the well children of the critically ill person. The findings suggest that the participants in the study attempted to offer valuable support to children visiting their critically ill family and friends, but, despite an open visiting policy, children rarely visited within this setting. The desire of the well parent to protect and shield the child from the crisis of critical illness was perceived by the participants to be the main reason why they did not visit. To provide family-centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom's health care system has also been identified and recommendations for further studies are proposed.

Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study.

PubMed

Dang, Bich N; Westbrook, Robert A; Njue, Sarah M; Giordano, Thomas P

2017-02-02

New patients are a particularly vulnerable population because they are at high risk of missing a subsequent visit or dropping out of care completely. However, few data exist on what new patients value in the beginning of a relationship with a new provider. Persons with HIV infection may be an ideal population to study the drivers of a positive initial patient-provider relationship, as it is a chronic and serious condition that requires a reliable, ongoing relationship with a provider. Informed by patients' real experiences, this study aims to identify what patients see as the most critical elements for building trust and rapport from the outset. We conducted longitudinal, in-person interviews with 21 patients new to the HIV clinic at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, from August 2013 to March 2015. Patients were interviewed across three time points: once before their first provider visit, a second time within two weeks after the first visit, and a third time at 6 to 12 months after the first provider visit. We conducted 61 h of patient interviews. The mean age was 53 years; 52% were non-Hispanic white, 23% were non-Hispanic black and 19% were Hispanic. Patients described significant anxiety and vulnerability not just from HIV itself, but also in starting a relationship as a new patient to a new provider. Our analysis of these experiences revealed five actions providers can take to reduce their patients' anxiety and build trust early in the first visit: 1) provide reassurance to patients, 2) tell patients it's okay to ask questions, 3) show patients their lab results and explain what they mean, 4) avoid language and behaviors that are judgmental of patients, and 5) ask patients what they want [i.e., treatment goals and preferences]. Our study incorporates direct input from patients and highlights the unique psychological challenges that patients face in seeking care from a new provider. The actionable opportunities cited by patients have the potential to mitigate patients' feelings of anxiety and vulnerability, and thereby improve their overall health care experience.

Physicians’ perceptions of medical representative visits in Yemen: a qualitative study

PubMed Central

2013-01-01

Background The pharmaceutical industry invests heavily in promotion, and it uses a variety of promotional strategies to influence physicians’ prescribing decisions. Within this context, medical representatives (MRs) are the key personnel employed in promoting their products. One significant consequence of the interactions between physicians and medical representatives is a conflict of interests which may contribute to the over prescribing of medications and thus negative effects on patients’ health and economics. There is limited detailed information published on the reasons why physicians interact with pharmaceutical representatives. This study aims to qualitatively explore physicians’ attitudes about interactions with medical representatives and their reasons for accepting the medical representatives’ visits. Methods In-depth interviews were used to gain a better understanding of physicians’ perceptions of medical representative visits. A total of 32 physicians from both private and public hospitals were interviewed. The recordings of the interviews were transcribed verbatim and subject to thematic analysis using a framework analysis approach. Results The present qualitative study found that the majority of the physicians had positive interactions with medical representatives. The physicians’ main reasons stated for allowing medical representatives’ visits are the social contacts and mutual benefits they will gain from these representatives. They also emphasized that the meeting with representatives provides educational and scientific benefits. A few physicians stated that the main reasons behind refusing the meeting with medical representatives were lack of conviction about the product and obligation to prescribe medicine from the representative company. Most of the physicians believed that they were under marketing pressure to prescribe certain medicines. Conclusions Although physicians are aware that the medical representatives could influence their prescribing decision, they welcome representatives to visit them and consider receiving free samples, gifts and various kinds of support as a normal practice. The findings provided insight into possible target areas for educational interventions concerning pharmaceutical marketing. Such a finding will provide the basis for policymakers in the public and private health sector in Yemen to develop a suitable policy and regulations in terms of drug promotion. PMID:23962304

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

PubMed Central

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

2015-01-01

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

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

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

NONE

1998-12-29

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

Characteristics of the original patient navigation programs to reduce disparities in the diagnosis and treatment of breast cancer.

PubMed

Vargas, Roberto B; Ryan, Gery W; Jackson, Catherine A; Rodriguez, Rian; Freeman, Harold P

2008-07-15

Patient navigation is an intervention developed to reduce disparities in cancer care that is being widely replicated and receiving considerable support for demonstration projects and research to test its effectiveness. In the current study, the authors present an in-depth descriptive analysis of the original patient navigation programs to inform current and future program development. A qualitative multistakeholder case study using interviews and site visits of the first patient navigation site and 2 sites subsequently developed by the leadership of the original site were evaluated. At these sites, patient navigation is a system, as opposed to a person, comprised primarily of navigators and directors that work together to remove barriers and facilitate access in a well-defined course of care; navigators were from the community or were culturally similar to the patient population served but were also paid employees of the clinical care site with detailed knowledge of the clinical course patients must traverse to complete care plans. Directors had administrative authority over the clinical facility and social capital across institutions, and communicated regularly and openly with navigators to implement system level changes to remove barriers to care. Contextual factors such as policies supporting breast cancer care also influenced the implementation of these programs. The first patient navigation programs combined community and culturally sensitive care-coordination with aspects of disease management programs to reduce racial, ethnic, and poverty-driven disparities in care. Future efforts to replicate and evaluate patient navigation should take into account these unique aspects of the original patient navigation programs. (c) 2008 American Cancer Society.

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

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

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

Self-reported information needs of anesthesia residency applicants and analysis of applicant-related web sites resources at 131 United States training programs.

PubMed

Chu, Larry F; Young, Chelsea A; Zamora, Abby K; Lowe, Derek; Hoang, Dan B; Pearl, Ronald G; Macario, Alex

2011-02-01

Despite the use of web-based information resources by both anesthesia departments and applicants, little research has been done to assess these resources and determine whether they are meeting applicant needs. Evidence is needed to guide anesthesia informatics research in developing high-quality anesthesia residency program Web sites (ARPWs). We used an anonymous web-based program (SurveyMonkey, Portland, OR) to distribute a survey investigating the information needs and perceived usefulness of ARPWs to all 572 Stanford anesthesia residency program applicants. A quantitative scoring system was then created to assess the quality of ARPWs in meeting the information needs of these applicants. Two researchers independently analyzed all 131 ARPWs in the United States to determine whether the ARPWs met the needs of applicants based on the scoring system. Finally, a qualitative assessment of the overall user experience of ARPWs was developed to account for the subjective elements of the Web site's presentation. Ninety-eight percent of respondents reported having used ARPWs during the application process. Fifty-six percent reported first visiting the Stanford ARPW when deciding whether to apply to Stanford's anesthesia residency program. Multimedia and Web 2.0 technologies were "very" or "most" useful in "learning intangible aspects of a program, like how happy people are" (42% multimedia and Web 2.0 versus 14% text and photos). ARPWs, on average, contained only 46% of the content items identified as important by applicants. The average (SD) quality scores among all ARPWs was 2.06 (0.59) of 4.0 maximum points. The mean overall qualitative score for all 131 ARPWs was 4.97 (1.92) of 10 points. Only 2% of applicants indicated that the majority (75%-100%) of Web sites they visited provided a complete experience. Anesthesia residency applicants rely heavily on ARPWs to research programs, prepare for interviews, and formulate a rank list. Anesthesia departments can improve their ARPWs by including information such as total hours worked and work hours by rotation (missing in 96% and 97% of ARPWs) and providing a valid web address on the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) (missing in 28% of ARPWs).

Overcoming Barriers to Integrating Behavioral Health and Primary Care Services

PubMed Central

Grazier, Kyle L.; Smiley, Mary L.; Bondalapati, Kirsten S.

2016-01-01

Objective: Despite barriers, organizations with varying characteristics have achieved full integration of primary care services with providers and services that identify, treat, and manage those with mental health and substance use disorders. What are the key factors and common themes in stories of this success? Methods: A systematic literature review and snowball sampling technique was used to identify organizations. Site visits and key informant interviews were conducted with 6 organizations that had over time integrated behavioral health and primary care services. Case studies of each organization were independently coded to identify traits common to multiple organizations. Results: Common characteristics include prioritized vulnerable populations, extensive community collaboration, team approaches that included the patient and family, diversified funding streams, and data-driven approaches and practices. Conclusions: While significant barriers to integrating behavioral health and primary care services exist, case studies of organizations that have successfully overcome these barriers share certain common factors. PMID:27380923

Installation-Restoration Program. Preliminary assessment; records search for the 155th Tactical Reconnaissance Group, Nebraska Air National Guard, Lincoln Municipal Airport, Lincoln, Nebraska

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

Not Available

1987-11-01

The Hazardous Materials Technical Center (HMTC) was retained in May 1986 to conduct the Installation-Restoration Program (IRP) Preliminary Assessment (PA) - Records Search for the 155th Tactical Reconnaissance Group (TRG), Nebraska Air National Guard, Lincoln Municipal Airport, Lincoln, Nebraska (hereinafter referred to as the Base). The Records Search included: an onsite visit including interviews with 19 Base personnel conducted by HMTC personnel on 21-23 May 1986; the acquisition and analysis of pertinent information and records on hazardous materials use and hazardous-waste generation and disposal at the Base; the acquisition and analysis of available geologic, hydrologic, meteorologic, and environmental data frommore » pertinent Federal, State, and local agencies; and the identification of sites on the Base that may be potentially contaminated with hazardous materials/hazardous wastes (HM/HW).« less

Safety Challenges and Improvement Strategies of Ethnic Minority Construction Workers: A Case Study in Hong Kong.

PubMed

Wu, Chunlin; Luo, Xiaowei; Wang, Tao; Wang, Yue; Sapkota, Bibek

2018-04-18

Due to cultural differences, ethnic minority construction workers are more difficult to manage and more vulnerable to accidents. This study aims to identify the major barriers faced by ethnic minority workers from their own perspectives and determine potential strategies to enhance safety climate of construction projects, thus ultimately improve their safety performance. A survey with modified Nordic safety climate questionnaire was conducted in a certain sub-contractor in Hong Kong. In-depth interviews, status quo description, major challenge investigation and safety knowledge tests were carried as well. The top three most important safety challenges identified are improper stereotypes from the whole industry, lack of opportunities for job assignment, and language barriers. To improve the safety performance, employers should allocate sufficient personal protective equipment and governments should organize unannounced site visits more frequently. Besides, the higher-level management should avoid giving contradictory instructions to foremen against to the standards of supervisors.

Structured identification of response options to address environmental health risks at the Agbogbloshie electronic waste site.

PubMed

Cazabon, Danielle; Fobil, Julius N; Essegbey, George; Basu, Niladri

2017-11-01

Electronic waste (e-waste) is a growing problem across low- and middle-income countries. Agbogbloshie (Accra, Ghana) is among the world's largest and most notorious e-waste sites, with an increasing number of studies documenting a range of environmental health risks. The present study aimed to provide national, regional, and international stakeholders with a summary of expert opinion on the most pressing problems arising from e-waste activities at Agbogbloshie, as well as suggested solutions to address these problems. Structured interviews were performed between April and September 2015 that used a Logical Framework Approach as a scoping exercise to gauge problems and benefits of e-waste recycling, and the Delphi methodology to identify response options. Stakeholders (n = 19) from 15 institutions were interviewed with 2 rounds of a Delphi Poll: open-ended interviews followed by an electronic questionnaire in which experts ranked various proposed response options based on health, environmental, social, and economic benefit and feasibility. The goal was to prioritize potential interventions that would address identified problems at Agbogbloshie. Experts identified the most beneficial and feasible options in decreasing rank order as follows and prefaced by the statement "it is recommended that": 1) there be further research on the health effects; 2) e-waste workers be given appropriate personal protective equipment; 3) the Ministry of the Environment, Science, Technology and Innovation re-visit Ghana's Hazardous Waste Bill; 4) e-waste workers be involved in the planning process of interventions and are be kept informed of any results; and 5) there be increased education and sensitization on hazards related to e-waste for both workers and the general public. These solutions are discussed in relation to ongoing dialogue at the international level concerning e-waste recycling interventions, with strengths and weaknesses examined for the Ghanaian context. Integr Environ Assess Manag 2017;13:980-991. ©2017 SETAC. © 2017 SETAC.

Nursing and healthcare students' experiences and use of e-learning in higher education.

PubMed

Moule, Pam; Ward, Rod; Lockyer, Lesley

2010-12-01

This paper presents research on nursing and healthcare students' experiences and use of e-learning. The inception of e-learning in higher education is supported by a policy background and technological developments, yet little is known of student experience and use in the United Kingdom. Conducted in 2007 and 2008, this study employed a mixed methods approach. An initial quantitative questionnaire was completed by 25 Higher Education Institutions and nine case study sites were visited. In the sites 41 students took part in focus groups and 35 staff were interviewed. Twenty-four Higher Education Institutions used a virtual learning environment and all respondents used e-learning to enable access to course materials and web-based learning resources. Three main themes were identified from student interviews, 'Pedagogic use'; 'Factors inhibiting use' and 'Facilitating factors to engagement'. Student's main engagement with e-learning was at an instructivist level and as a support to existing face-to-face modes of delivery. Student use of Web 2.0 was limited, although a number were using social software at home. Limited computer access, computing skills, technical issues and poor peer commitment affected use. Motivation and relevance to the course and practice, in addition to an appreciation of the potential for student-centred and flexible learning, facilitated use. There is scope to broaden the use of e-learning that would engage students in the social construction of knowledge. In addition, experiences of e-learning use could be improved if factors adversely affecting engagement were addressed. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

Designing and implementing an authentic science research program

NASA Astrophysics Data System (ADS)

Rosvally, Harry Edward, Jr.

Science research programs have become a popular elective course in high schools around the country. As the popularity of these programs grows, school districts need a guide by which to implement science research in their own schools. This study sought to provide this information by answering the following questions: (1) What are the most important features in existing research program models? (2) How do schools that have an existing research program define "success"? (3) How do different factors (i.e., budget, professional development, scheduling, recruitment effort, curriculum, and mentors) affect the scope and implementation of a research program? (4) Which features and factors support inclusiveness as a goal for a research program? (5) What kinds of indicators are appropriate for assessing the progress toward an inclusive science research program? After reviewing the literature, six sites with existing research programs were selected for participation in the study. Interviews with teachers and students were conducted during site visits. Interviews with mentors were conducted by telephone. Although the six models in this study were different from one another, there were common characteristics. Students conducted their own review of the literature. Upon completion of the actual research, students published or otherwise communicated their findings to the larger scientific community through regional and national competitions and non-competitive science symposia. This study was also able to identify significant elements that contribute to successful programs. These included: teacher selection; budget requirements; mentor qualities; recruitment and retention practices; and overall structure. As a result of the findings during the research, this study makes recommendations for the successful implementation of a research program.

Healthy Amistad: improving the health of people with severe mental illness.

PubMed

Martin, Maurice Bud; Martin, Sarah L

2014-10-01

Here, we report evaluation results of implementing a health promotion program for individuals with serious mental illnesses. Healthy Amistad aimed to address four behaviors: physical inactivity, nutrition choices, smoking, and seeking access to health care. The evaluation employed a mixed-method study design to assess changes in the health of individuals in the program. Process measures assessed the implementation of the program. A pre-post examination was used to compare data associated with behaviors. Data sources included the 2008 and 2009 annual surveys, clinical data, interviews for staff, interviews with members, and an on-site observation. Participants were staff and members of Amistad. Those involved with the Peer Patient Navigator lost weight; new physically active activities were being offered. A new salad bar and healthier menu was offered in the Amistad cafeteria. Interviews revealed that 11 members lost a total of 150 pounds. The percentage reporting visits to an emergency room more than once in the last 6 months decreased from 58% to 37%, the percentage calling the crisis line less often increased from 75% to 86%, and the percentage reporting that they had become more satisfied with their life since joining Amistad improved from 76% to 88%. Individuals with serious mental illnesses are benefiting from programs that focus on the mitigation of disease states manifested from issues with physical inactivity, nutrition, smoking, and health access. Evaluation of the Healthy Amistad program has shown a positive influence.

An Empty Toolbox? Changes in Health Plans’ Approaches for Managing Costs and Care

PubMed Central

Mays, Glen P; Hurley, Robert E; Grossman, Joy M

2003-01-01

Objective To examine how health plans have changed their approaches for managing costs and utilization in the wake of the recent backlash against managed care. Data Sources/Study Setting Semistructured interviews with health plan executives, employers, providers, and other health care decision makers in 12 metropolitan areas that were randomly selected to be nationally representative of communities with more than 200,000 residents. Longitudinal data were collected as part of the Community Tracking Study during three rounds of site visits in 1996–1997, 1998–1999, and 2000–2001. Study Design Interviews probed about changes in the design and operation of health insurance products—including provider contracting and network development, benefit packages, and utilization management processes—and about the rationale and perceived impact of these changes. Data Collection/Extraction Methods Data from more than 850 interviews were coded, extracted, and analyzed using computerized text analysis software. Principal Findings Health plans have begun to scale back or abandon their use of selected managed care tools in most communities, with selective contracting and risk contracting practices fading most rapidly and completely. In turn, plans increasingly have sought cost savings by shifting costs to consumers. Some plans have begun to experiment with new provider networks, payment systems, and referral practices designed to lower costs and improve service delivery. Conclusions These changes promise to lighten administrative and financial burdens for physicians and hospitals, but they also threaten to increase consumers’ financial burdens. PMID:12650372

Interactive Exhibits Foster Partnership and Engage Diverse Learners at Their Local Libraries

NASA Astrophysics Data System (ADS)

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

2016-12-01

Learners frequently need to access increasingly complex information to help them understand our changing world. More and more libraries are transforming themselves into places where learners not only access STEM information, but interact with professionals and undertake hands-on learning. Libraries are beginning to position themselves as part of learning ecosystems that contribute to a collective impact on the community. Traveling STEM exhibits are catalyzing these partnerships and engaging students, families, and adults in repeat visits through an accessible venue: their public library. The impact of the STAR Library Education Network's (STAR_Net) Discover Earth: A Century of Change exhibit on partnerships, the circulation of STEM resources, and the engagement of learners was studied by an external evaluation team. The STAR_Net project's summative evaluation utilized mixed methods to investigate project implementation and its outcomes. Methods included pre- and post-exhibit surveys administered to staff from each library that hosted the exhibits; interviews with staff from host libraries; patron surveys; exhibit-related circulation records; web metrics regarding the online STAR_Net community of practice; and site visits. A subset of host libraries recruited professionals, who delivered programming that connected Earth systems science, weather, climate, and conservation themes from the exhibit to local issues. Library patrons improved their knowledge about STEM topics presented in the exhibits and associated programming, and patrons viewing the exhibit reflected the demographics of their communities. In a follow-up survey, patrons reported spending an average of 60 minutes looking at the exhibit over their cumulative visits to the library. In contrast, visitors might visit a museum only once to look at a comparably-sized traveling exhibit due to barriers such as cost and distance. Exhibit host libraries reported an increase in the circulation of Earth science materials of 27% while the exhibit was at their library. The summative evaluation results, as well as tips for working with your local library, will be shared.

Inexpensive automated paging system for use at remote research sites

USGS Publications Warehouse

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

1998-01-01

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

EEAP boiler and chiller study II at Fort Sam Houston, San Antonio, Texas. Volume II

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

NONE

The following assumptions and estimates were used in the modeling of the existing buildings which are served by the boilers and chillers included in this study. (1) The Trace 600 weather data for San Antonio, Texas was used in all of the computer simulations. (2) The Trace 600 computer simulations were performed for the months of January through December to determine annual HVAC equipment energy consumptions. (3) A special holiday schedule was created to incorporate the additional holidays that military personnel living in the area 1300 barracks buildings receive. This schedule includes the seven standard holidays plus the period frommore » December 17 through 31. The standard seven day holiday schedule was used for all other areas. (4) All building dimensions and construction data were determined from as-built drawings when available, or from field measurements taken during the site visit. (5) Design room temperatures for comfort conditions (thermostat setpoints) were obtained from CEMP-E (9 December 1991) Chapter 13, Section 3. These temperatures were 78 deg F, 50% relative humidity for cooling and 70 deg F for heating. No cooling or heating temperature setback control was included in the simulations. The design room conditions for the hospital were determined as follows: Surgery / Critical Care 68 deg F, 55%; Ancillary 72 deg F, 50%; Nursing / Patient Care 76 deg F, 50%; and Computer Room 72 deg F, 50%. (6) The shading coefficient for all windows with interior shading devices was estimated at 0.67 per ASHRAE data. (7) The number of people in each building or room was estimated from interviews with post personnel or field notes taken during the site visit. The sensible and latent heat gain rates used for the people in each room were taken from ASHRAE data.« less

A closer look at the relationships between panic attacks, emergency department visits and non-cardiac chest pain.

PubMed

Foldes-Busque, Guillaume; Denis, Isabelle; Poitras, Julien; Fleet, Richard P; Archambault, Patrick; Dionne, Clermont E

2017-01-01

This study examined the prevalence of emergency department visits prompted by panic attacks in patients with non-cardiac chest pain. A validated structured telephone interview was used to assess panic attacks and their association with the emergency department consultation in 1327 emergency department patients with non-cardiac chest pain. Patients reported at least one panic attack in the past 6 months in 34.5 per cent (95% confidence interval: 32.0%-37.1%) of cases, and 77.1 per cent (95% confidence interval: 73.0%-80.7%) of patients who reported panic attacks had visited the emergency department with non-cardiac chest pain following a panic attack. These results indicate that panic attacks may explain a significant proportion of emergency department visits for non-cardiac chest pain.

Amoebiasis among patrons visiting gay saunas in Taiwan.

PubMed

Hung, C-C; Ko, N-Y; Ko, W-C; Lee, H-C; Ji, D-D; Liu, W-C; Chang, S-C

2008-10-01

This study aimed to assess the prevalence of amoebiasis among patrons visiting gay saunas in Taiwan. A cross-sectional survey was conducted using questionnaire interview and indirect hemagglutination assays and specific Entamoeba histolytica antigen assays of blood and rectal swab specimens, respectively, among patrons visiting 10 gay saunas between September 2006 and December 2006. During the three-month study period, 208 blood and 120 rectal swab specimens were tested for E. histolytica infection. Amoebiasis was detected among 3.8% and 3.3% of the patrons by serologies and antigen assays, respectively. During the latest sexual encounter, more than 70% of the patrons had oral-anogenital sex, and only 20% used condoms during oral-anogenital contact. Our findings suggest that there is a potential risk of E. histolytica transmission among the patrons visiting gay saunas who do not practise safe sex consistently in Taiwan.

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

PubMed

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

2018-01-01

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

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

PubMed

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

2001-08-01

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

Motivational interviewing interactions and the primary health care challenges presented by smokers with low motivation to stop smoking: a conversation analysis.

PubMed

Codern-Bové, Núria; Pujol-Ribera, Enriqueta; Pla, Margarida; González-Bonilla, Javier; Granollers, Silvia; Ballvé, José L; Fanlo, Gemma; Cabezas, Carmen

2014-11-26

Research indicates that one third of smokers have low motivation to stop smoking. The purpose of the study was to use Conversational Analysis to enhance understanding of the process in Motivational Interviewing sessions carried out by primary care doctors and nurses to motivate their patients to quit smoking. The present study is a substudy of the Systematic Intervention on Smoking Habits in Primary Health Care Project (Spanish acronym: ISTAPS). Motivational interviewing sessions with a subset of nine participants (two interview sessions were conducted with two of the nine) in the ISTAPS study who were current smokers and scored fewer than 5 points on the Richmond test that measures motivation to quit smoking were videotaped and transcribed. A total of 11 interviews conducted by five primary health care professionals in Barcelona, Spain, were analysed. Qualitative Content Analysis was used to develop an analytical guide for coding transcriptions. Conversation Analysis allowed detailed study of the exchange of words during the interaction. Motivational Interviewing sessions had three phases: assessment, reflection on readiness to change, and summary. The interaction was constructed during an office visit, where interactional dilemmas arise and can be resolved in various ways. Some actions by professionals (use of reiterations, declarations, open-ended questions) helped to construct a framework of shared relationship; others inhibited this relationship (focusing on risks of smoking, clinging to the protocol, and prematurely emphasizing change). Some professionals tended to resolve interactional dilemmas (e.g., resistance) through a confrontational or directive style. Interactions that did not follow Motivational Interviewing principles predominated in seven of the interviews analysed. Conversational analysis showed that the complexity of the intervention increases when a health professional encounters individuals with low motivation for change, and interactional dilemmas may occur that make it difficult to follow Motivational Interview principles. Incorporating different forms of expression during the Motivational Interviewing could help to build patient-centred health care relationships and, for patients with low motivation to stop smoking, offer an opportunity to reflect on tobacco use during the office visit. The study findings could be included in professional training to improve the quality of motivational interviewing.

Promoting interprofessional learning with medical students in home care settings.

PubMed

Solomon, Patricia; Risdon, Cathy

2011-01-01

The home care setting is ideal for medical students to learn about the importance of interprofessional collaboration in the community. This project examined the impact of a unique program designed to facilitate medical students' knowledge and awareness of the challenges of interprofessional care in the home. In pairs, medical students participated in two community visits with preceptors from different professions. Students completed a structured personal reflection after their first visit. Students and preceptors participated in focus groups or interviews to identify strengths and challenges of the experiences. The structured reflections and the focus group and interview transcripts were analyzed qualitatively. 164 medical students and 36 preceptors participated in 326 visits. There were high ratings of satisfaction from students and preceptors. Students developed unexpected insights into peoples' lives, developed a greater understanding of the patient's perspective and determinants of health, learned about others' scope of practice, and developed an appreciation of the limitations of their own scope of practice. Preceptors had high expectations for student performance and engagement and enjoyed the opportunity to impart their knowledge to future physicians. Although organizationally complex, the program evaluation suggestions that students and preceptors benefit from interprofessional experiences in the home.

"I'm not abusing or anything": patient-physician communication about opioid treatment in chronic pain.

PubMed

Matthias, Marianne S; Krebs, Erin E; Collins, Linda A; Bergman, Alicia A; Coffing, Jessica; Bair, Matthew J

2013-11-01

To characterize clinical communication about opioids through direct analysis of clinic visits and in-depth interviews with patients. This was a pilot study of 30 patients with chronic pain, who were audio-recorded in their primary care visits and interviewed after the visit about their pain care and relationship with their physicians. Emergent thematic analysis guided data interpretation. Uncertainties about opioid treatment for chronic pain, particularly addiction and misuse, play an important role in communicating about pain treatment. Three patterns of responding to uncertainty emerged in conversations between patients and physicians: reassurance, avoiding opioids, and gathering additional information. Results are interpreted within the framework of Problematic Integration theory. Although it is well-established that opioid treatment for chronic pain poses numerous uncertainties, little is known about how patients and their physicians navigate these uncertainties. This study illuminates ways in which patients and physicians face uncertainty communicatively and collaboratively. Acknowledging and confronting the uncertainties inherent in chronic opioid treatment are critical communication skills for patients taking opioids and their physicians. Many of the communication behaviors documented in this study may serve as a model for training patients and physicians to communicate effectively about opioids. Published by Elsevier Ireland Ltd.

Transfer of knowledge in international cooperation: the Farmanguinhos – SMM case

PubMed Central

da Silva, Samuel Araujo Gomes; Duarte, Roberto Gonzalez; de Castro, José Márcio

2017-01-01

ABSTRACT OBJECTIVE To analyze the influence of four mechanisms of knowledge transfer (training, technical visits, expatriation, and standard operating procedures) on the different dimensions (potential and realized) of absorptive capacity in international technical cooperation. METHODS We examine the case of implementation of the Sociedade Moçambicana de Medicamentos. Data have been collected using semi-structured interviews (applied to 21 professionals of the Sociedade Moçambicana de Medicamentos, Farmanguinhos, FIOCRUZ, and Itamaraty) and official documents. The data of the interviews have been submitted to content analysis, using the software NVivo. RESULTS Training and technical visits directly influenced the acquisition and, partly, the assimilation of knowledge. Expatriation contributed with the transformation of this knowledge from the development and refinement of operational routines. Finally, the definition of standard operating procedures allowed the Mozambican technicians to be the actors of the transformation of the knowledge previously acquired and assimilated and, at the same time, it laid the foundations for a future exploration of the knowledge. CONCLUSIONS Training and technical visits mainly influence the potential absorptive capacity, while expatriation and standard operating procedures most directly affect the realized absorptive capacity. PMID:29166441

The reliability of the standard for clinicians' interview in psychiatry (SCIP): a clinician-administered tool with categorical, dimensional and numeric output.

PubMed

Aboraya, Ahmed; El-Missiry, Ahmed; Barlowe, Johnna; John, Collin; Ebrahimian, Alireza; Muvvala, Srinivas; Brandish, Ja'me; Mansour, Hader; Zheng, Wanhong; Chumber, Paramjit; Berry, James; Elswick, Daniel; Hill, Cheryl; Swager, Lauren; Abo Elez, Warda; Ashour, Hala; Haikal, Amal; Eissa, Ahmed; Rabie, Menan; El-Missiry, Marwa; El Sheikh, Mona; Hassan, Dina; Ragab, Sherif; Sabry, Mohamed; Hendawy, Heba; Abdel Rahman, Rola; Radwan, Doaa; Sherif, Mohamed; Abou El Asaad, Marwa; Khalil, Sherien; Hashim, Reem; Border, Katherine; Menguito, Roberto; France, Cheryl; Hu, Wei; Shuttleworth, Olivia; Price, Elizabeth

2014-07-01

Existing standardized diagnostic interviews are not used by psychiatrists in clinical settings. There is an urgent need for a clinician-administered tool for assessment of adult psychopathology that produces dimensional measures, in addition to categorical diagnoses. The Standard for Clinicians' Interview in Psychiatry (SCIP) was designed to be used in clinical settings and generates dimensional measures. The reliability of the SCIP was tested at six sites: one hospital and two clinics in USA, two hospitals in Egypt and one clinic in Canada. Participants were adult patients who were admitted for inpatient psychiatric treatment or came for regular office visits in the outpatient clinic. Refusal rate was <1%. Missing data were <1.1%. Patients with dementia, mental retardation or serious medical conditions were excluded. A total of 1,004 subjects were interviewed between 2000 and 2012. Inter-rater reliability (Kappa) was measured for 150 SCIP items: 116 items (77.3%) had good reliability (Kappa>0.7), 28 items (18.7%) had fair reliability (Kappa ranges from 0.5 to 0.7) and six items (4%) had poor reliability (Kappa<0.5). Cronbach's alpha for internal consistency was measured for the SCIP dimensions: anxiety, posttraumatic stress, depression, mania, hallucinations, Schneider first-rank symptoms, delusions, disorganized thoughts, disorganized behavior, negative symptoms, alcohol addiction, drug addiction, attention and hyperactivity. All of the SCIP dimensions had substantial Cronbach's alpha values (>0.7) with the exception of disorganized thoughts (Cronbach's alpha=0.375). The SCIP is a reliable tool for assessing psychological symptoms, signs and dimensions of the main psychiatric diagnoses. Copyright © 2014 Elsevier B.V. All rights reserved.

Quarterly Performance/Technical Report of the National Marrow Donor Program

DTIC Science & Technology

2010-11-05

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

West Europe Report

DTIC Science & Technology

1987-01-21

BELGIUM Gol Criticizes CVP on Regional Financing Issues ( Jean Gol Interview; LE SOIR, 14 Nov 86) 52 FINLAND SPAIN Nordic Economic Unity Needs...FLNKS PLANS Paris ROUGE in French 27 Nov-3 Dec 86 p 15 [Interview with FLNKS President Jean -Marie Tjibaou by Alain Krivine in France; date not...given] [Text] Jean -Marie Tjibaou has just paid a visit to France. Chirac, noting his mistrust of the Kanaks, refused to see him. The president of the

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

PubMed

Wawrzynski, Mary; Davidhizar, Ruth

2004-01-01

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

Chronic obstructive pulmonary disease, hospital visits, and comorbidities: National Survey of Residential Care Facilities, 2010.

PubMed

Wheaton, Anne G; Ford, Earl S; Cunningham, Timothy J; Croft, Janet B

2015-04-01

To characterize the prevalence of chronic obstructive pulmonary disease (COPD) among residential care facility (RCF) residents in the United States, and to compare patterns of hospital visits and comorbidities with residents without COPD. Resident data from the 2010 National Survey of Residential Care Facilities were analyzed. Medical history and information on past-year hospital visits for 8,089 adult residents were obtained from interviews with RCF staff. COPD prevalence was 12.4%. Compared with residents without COPD, emergency department visits or overnight hospital stays in the previous year were more prevalent (p < .05) among residents with COPD. Less than 3% of residents with COPD had no comorbidities. Arthritis, depression, congestive heart failure (CHF), diabetes, coronary heart disease, and asthma were more common (p < .05) among residents with COPD than those without COPD, but Alzheimer's disease was less common. COPD is associated with more emergency department visits, hospital stays, and comorbidities among RCF residents. © The Author(s) 2014.

A Learning Collaborative Approach to Improve Primary Care STI Screening.

PubMed

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

2017-10-01

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

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

PubMed

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

2012-08-01

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

Outdoor air pollution and uncontrolled asthma in the San Joaquin Valley, California.

PubMed

Meng, Ying-Ying; Rull, Rudolph P; Wilhelm, Michelle; Lombardi, Christina; Balmes, John; Ritz, Beate

2010-02-01

The San Joaquin Valley (SJV) in California ranks among the worst in the USA in terms of air quality, and its residents report some of the highest rates of asthma symptoms and asthma-related emergency department (ED) visits and hospitalisations in California. Using California Health Interview Survey data, the authors examined associations between air pollution and asthma morbidity in this region. Eligible subjects were SJV residents (2001 California Health Interview Survey) who reported physician-diagnosed asthma (n=1502, 14.6%). The authors considered two outcomes indicative of uncontrolled asthma: (1) daily or weekly asthma symptoms and (2) asthma-related ED visits or hospitalisation in the past year. Based on residential zip code, subjects were assigned annual average concentrations of ozone, PM(10) and PM(2.5) for the 1-year period prior to the interview date from their closest government air monitoring station within an 8 km (5 miles) radius. Adjusting for age, gender, race/ethnicity, poverty level and insurance status, the authors observed increased odds of experiencing daily or weekly asthma symptoms for ozone, PM(10) and PM(2.5) (OR(ozone) 1.23, 95% CI 0.94 to 1.60 per 10 ppb; OR(PM10) 1.29, 95% CI 1.05 to 1.57 per 10 microg/m(3); and OR(PM2.5) 1.82; 95% CI 1.11 to 2.98 per 10 microg/m(3)). The authors also observed increased odds of asthma-related ED visits or hospitalisations for ozone (OR 1.49, 95% CI 1.05 to 2.11 per 10 ppb) and a 29% increase in odds for PM(10) (OR 1.29, 95% CI 0.99 to 1.69 per 10 microg/m(3)). Overall, these findings suggest that individuals with asthma living in areas of the SJV with high ozone and particulate pollution levels are more likely to have frequent asthma symptoms and asthma-related ED visits and hospitalisations.

Health Insurance Benefit Design and Healthcare Utilization in Northern Rural China

PubMed Central

Wang, Hong; Liu, Yu; Zhu, Yan; Xue, Lei; Dale, Martha; Sipsma, Heather; Bradley, Elizabeth

2012-01-01

Background Poverty due to illness has become a substantial social problem in rural China since the collapse of the rural Cooperative Medical System in the early 1980s. Although the Chinese government introduced the New Rural Cooperative Medical Schemes (NRCMS) in 2003, the associations between different health insurance benefit package designs and healthcare utilization remain largely unknown. Accordingly, we sought to examine the impact of health insurance benefit design on health care utilization. Methods and Findings We conducted a cross-sectional study using data from a household survey of 15,698 members of 4,209 randomly-selected households in 7 provinces, which were representative of the provinces along the north side of the Yellow River. Interviews were conducted face-to-face and in Mandarin. Our analytic sample included 9,762 respondents from 2,642 households. In each household, respondents indicated the type of health insurance benefit that the household had (coverage for inpatient care only or coverage for both inpatient and outpatient care) and the number of outpatient visits in the 30 days preceding the interview and the number of hospitalizations in the 365 days preceding the household interview. People who had both outpatient and inpatient coverage compared with inpatient coverage only had significantly more village-level outpatient visits, township-level outpatient visits, and total outpatient visits. Furthermore, the increased utilization of township and village-level outpatient care was experienced disproportionately by people who were poorer, whereas the increased inpatient utilization overall and at the county level was experienced disproportionately by people who were richer. Conclusion The evidence from this study indicates that the design of health insurance benefits is an important policy tool that can affect the health services utilization and socioeconomic equity in service use at different levels. Without careful design, health insurance may not benefit those who are most in need of financial protection from health services expenses. PMID:23185616

Health insurance benefit design and healthcare utilization in northern rural China.

PubMed

Wang, Hong; Liu, Yu; Zhu, Yan; Xue, Lei; Dale, Martha; Sipsma, Heather; Bradley, Elizabeth

2012-01-01

Poverty due to illness has become a substantial social problem in rural China since the collapse of the rural Cooperative Medical System in the early 1980s. Although the Chinese government introduced the New Rural Cooperative Medical Schemes (NRCMS) in 2003, the associations between different health insurance benefit package designs and healthcare utilization remain largely unknown. Accordingly, we sought to examine the impact of health insurance benefit design on health care utilization. We conducted a cross-sectional study using data from a household survey of 15,698 members of 4,209 randomly-selected households in 7 provinces, which were representative of the provinces along the north side of the Yellow River. Interviews were conducted face-to-face and in Mandarin. Our analytic sample included 9,762 respondents from 2,642 households. In each household, respondents indicated the type of health insurance benefit that the household had (coverage for inpatient care only or coverage for both inpatient and outpatient care) and the number of outpatient visits in the 30 days preceding the interview and the number of hospitalizations in the 365 days preceding the household interview. People who had both outpatient and inpatient coverage compared with inpatient coverage only had significantly more village-level outpatient visits, township-level outpatient visits, and total outpatient visits. Furthermore, the increased utilization of township and village-level outpatient care was experienced disproportionately by people who were poorer, whereas the increased inpatient utilization overall and at the county level was experienced disproportionately by people who were richer. The evidence from this study indicates that the design of health insurance benefits is an important policy tool that can affect the health services utilization and socioeconomic equity in service use at different levels. Without careful design, health insurance may not benefit those who are most in need of financial protection from health services expenses.

Barriers to patient-centered human immunodeficiency virus (HIV) care with African American patients who use drugs: Social construction of the typical and ideal care visit.

PubMed

Carlberg-Racich, Suzanne; Roden, Lindsey

2017-01-01

A successful patient-provider relationship ensures that patients are treated as individuals and receive appropriate care for their unique circumstances. For this to occur, the relationship needs open communication and trust. African American persons who inject drugs (PWIDs) and who smoke crack cocaine are at elevated risks of poor health outcomes and are often lost to care. In addition, providers often experience difficulty serving this population. Although some barriers are documented in the peer-reviewed literature, this study sought to provide in-depth context to the relationship and how it is constructed. Individual, semistructured interviews were conducted with human immunodeficiency virus (HIV) care providers and their patients, specifically PWIDs and persons who smoke crack cocaine, in publicly funded HIV clinics in low-resource urban communities. n = 31 patients and n = 7 providers were interviewed about their perceptions of the other and the relationship. Interview transcripts were coded and analyzed for common themes, which were used to generate a conceptual, constructionist model of the HIV care visit. Common patient themes included the tendency to describe providers in familial terms, match between their current provider and ideal provider, concern about stigma related to their use, and expression of unmet needs. Provider themes revealed less match with their ideal patient-preferring patients who were both abstinent and adherent, and expressing frustration with patient refusal to change. Thematic results were used to create a visual and conceptual model for the HIV care visit. The model demonstrates both the positive and negative perceptions that inform the visit, and the barriers that impede a more fruitful patient-provider dynamic with a shared power structure. Provider training in communication and other identified topics may begin to lay the foundation for a shift in this structure.

Using social media to quantify nature-based tourism and recreation

PubMed Central

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

2013-01-01

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

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

PubMed

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

2013-10-17

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

AGU Career Center attracts hundreds of Fall Meeting attendees

NASA Astrophysics Data System (ADS)

Cooper, Paul

2012-02-01

The poster hall of the 2011 AGU Fall Meeting was the venue not only for scientific discussion and exchange of ideas—Fall Meeting attendees also explored new career opportunities and received career advice at AGU's Career Center. For many years, recruiters and hiring managers have found ideal candidates for open positions during the AGU Fall Meeting through the Career Center. Last year was no exception: Recruiters browsed resumés, visited posters, and attended talks to find talented individuals to interview during the week. In addition, hundreds of meeting attendees looking for a new job or a postdoc position visited the Career Center and checked the online AGU Career Center job board to request interviews. Career counselor Alaina Levine of Quantum Success Solutions gave private one-on-one career advice to 47 meeting attendees, making sure that each individual she counseled left the session with clearer career objectives and tactics to bring these objectives to fruition.

Electronic communication improves access, but barriers to its widespread adoption remain.

PubMed

Bishop, Tara F; Press, Matthew J; Mendelsohn, Jayme L; Casalino, Lawrence P

2013-08-01

Because electronic communication is quick, convenient, and inexpensive for most patients, care that is truly patient centered should promote the use of such communication between patients and providers, even using it as a substitute for office visits when clinically appropriate. Despite the potential benefits of electronic communication, fewer than 7 percent of providers used it in 2008. To learn from the experiences of providers that have widely incorporated electronic communication into patient care, we interviewed leaders of twenty-one medical groups that use it extensively with patients. We also interviewed staff in six of those groups. Electronic communication was widely perceived to be a safe, effective, and efficient means of communication that improves patient satisfaction and saves patients time but that increases the volume of physician work unless office visits are reduced. Practice redesign and new payment methods are likely necessary for electronic communication to be more widely used in patient care.

Reflexive photography: an alternative method for documenting the learning process of cultural competence.

PubMed

Amerson, Roxanne; Livingston, Wade G

2014-04-01

This qualitative descriptive study used reflexive photography to evaluate the learning process of cultural competence during an international service-learning project in Guatemala. Reflexive photography is an innovative qualitative research technique that examines participants' interactions with their environment through their personal reflections on images that they captured during their experience. A purposive sample of 10 baccalaureate nursing students traveled to Guatemala, where they conducted family and community assessments, engaged in home visits, and provided health education. Data collection involved over 100 photographs and a personal interview with each student. The themes developed from the photographs and interviews provided insight into the activities of an international experience that influence the cognitive, practical, and affective learning of cultural competence. Making home visits and teaching others from a different culture increased students' transcultural self-efficacy. Reflexive photography is a more robust method of self-reflection, especially for visual learners.

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

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

Byerly, D.W.

1976-06-01

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

Dental care providers' and patients' perceptions of the effect of health information technology in the dental care setting.

PubMed

Asan, Onur; Ye, Zhan; Acharya, Amit

2013-09-01

The use of electronic health records (EHRs) in dental care and their effect on dental care provider-patient interaction have not been studied sufficiently. The authors conducted a study to explore dental care providers' interactions with EHRs during patient visits, how these interactions influence dental care provider-patient communication, and the providers' and patients' perception of EHR use in the dental clinic setting during patient visits. The authors collected survey and interview data from patients and providers at three dental clinics in a health care system. The authors used qualitative and quantitative methods to analyze data obtained from patients and dental care providers. The provider survey results showed significant differences in perceptions of EHR use in patient visits across dental care provider groups (dentists, dental hygienists and dental assistants). Patient survey results indicated that some patients experienced a certain level of frustration and distraction because of providers' use of EHRs during the visit. The provider survey results indicated that there are different perceptions across provider groups about EHRs and the effect of computer use on communication with patients. Dental assistants generally reported more negative effects on communication with patients owing to computer use. Interview results also indicated that dental care providers may not feel comfortable interacting with the EHR without having any verbal or eye contact with patients during the patient's dental visit. A new design for dental operatories and locations of computer screens within the operatories should be undertaken to prevent negative nonverbal communication such as loss of eye contact or forcing the provider and patient to sit back to back, as well as to enhance patient education and information sharing.

A prospective study of mental health care for comorbid depressed mood in older adults with painful osteoarthritis

PubMed Central

2011-01-01

Background Comorbid depression is common among adults with painful osteoarthritis (OA). We evaluated the relationship between depressed mood and receipt of mental health (MH) care services. Methods In a cohort with OA, annual interviews assessed comorbidity, arthritis severity, and MH (SF-36 mental health score). Surveys were linked to administrative health databases to identify mental health-related visits to physicians in the two years following the baseline interview (1996-98). Prescriptions for anti-depressants were ascertained for participants aged 65+ years (eligible for drug benefits). The relationship between MH scores and MH-related physician visits was assessed using zero-inflated negative binomial regression, adjusting for confounders. For those aged 65+ years, logistic regression examined the probability of receiving any MH-related care (physician visit or anti-depressant prescription). Results Analyses were based on 2,005 (90.1%) individuals (mean age 70.8 years). Of 576 (28.7%) with probable depression (MH score < 60/100), 42.5% experienced one or more MH-related physician visits during follow-up. The likelihood of a physician visit was associated with sex (adjusted OR women vs. men = 5.87, p = 0.005) and MH score (adjusted OR per 10-point decrease in MH score = 1.63, p = 0.003). Among those aged 65+, 56.7% with probable depression received any MH care. The likelihood of receiving any MH care exhibited a significant interaction between MH score and self-reported health status (p = 0.0009); with good general health, worsening MH was associated with increased likelihood of MH care; as general health declined, this effect was attenuated. Conclusions Among older adults with painful OA, more than one-quarter had depressed mood, but almost half received no mental health care, suggesting a care gap. PMID:21910895

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

PubMed

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

2018-01-01

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

In-office Discussions of Migraine: Results from the American Migraine Communication Study

PubMed Central

Hahn, Steven R.; Cady, Roger K.; Brandes, Jan Lewis; Simons, Suzanne E.; Bain, Philip A.; Nelson, Meaghan R.

2008-01-01

Background Research indicates that successful migraine assessment and treatment depends on information obtained during patient and healthcare professional (HCP) discussions. However, no studies outline how migraine is actually discussed during clinical encounters. Objective Record naturally occurring HCP–migraineur interactions, analyzing frequency and impairment assessment, and preventive treatment discussions. Design HCPs seeing high volumes of migraineurs were recruited for a communication study. Patients likely to discuss migraine were recruited immediately before their normally scheduled appointment and, once consented, were audio- and video-recorded without a researcher present. Separate post-visit interviews were conducted with patients and HCPs. All interactions were transcribed. Participants Sixty patients (83% female; mean age 41.7) were analyzed. Patients were diagnosed with migraine 14 years and experienced 5 per month, on average. Approach Transcripts were analyzed using sociolinguistic techniques such as number and type of questions asked and post-visit alignment on migraine frequency and impairment. American Migraine Prevalence and Prevention Study guidelines were utilized. Results Ninety-one percent of HCP-initiated, migraine-specific questions were closed-ended/short answer; assessments focused on frequency and did not focus on attention on impairment. Open-ended questions in patient post-visit interviews yielded robust impairment-related information. Post-visit, 55% of HCP–patient pairs were misaligned regarding frequency; 51% on impairment. Of the 20 (33%) patients who were preventive medication candidates, 80% did not receive it and 50% of their visits lacked discussion of prevention. Conclusions Sociolinguistic analysis revealed that HCPs often used narrowly focused, closed-ended questions and were often unaware of how migraine affected patients’ lives as a result. It is recommended that HCPs assess impairment using open-ended questions in combination with the ask-tell-ask technique. PMID:18459012

In-office discussions of migraine: results from the American Migraine Communication Study.

PubMed

Lipton, Richard B; Hahn, Steven R; Cady, Roger K; Brandes, Jan Lewis; Simons, Suzanne E; Bain, Philip A; Nelson, Meaghan R

2008-08-01

Research indicates that successful migraine assessment and treatment depends on information obtained during patient and healthcare professional (HCP) discussions. However, no studies outline how migraine is actually discussed during clinical encounters. Record naturally occurring HCP-migraineur interactions, analyzing frequency and impairment assessment, and preventive treatment discussions. HCPs seeing high volumes of migraineurs were recruited for a communication study. Patients likely to discuss migraine were recruited immediately before their normally scheduled appointment and, once consented, were audio- and video-recorded without a researcher present. Separate post-visit interviews were conducted with patients and HCPs. All interactions were transcribed. Sixty patients (83% female; mean age 41.7) were analyzed. Patients were diagnosed with migraine 14 years and experienced 5 per month, on average. Transcripts were analyzed using sociolinguistic techniques such as number and type of questions asked and post-visit alignment on migraine frequency and impairment. American Migraine Prevalence and Prevention Study guidelines were utilized. Ninety-one percent of HCP-initiated, migraine-specific questions were closed-ended/short answer; assessments focused on frequency and did not focus on attention on impairment. Open-ended questions in patient post-visit interviews yielded robust impairment-related information. Post-visit, 55% of HCP-patient pairs were misaligned regarding frequency; 51% on impairment. Of the 20 (33%) patients who were preventive medication candidates, 80% did not receive it and 50% of their visits lacked discussion of prevention. Sociolinguistic analysis revealed that HCPs often used narrowly focused, closed-ended questions and were often unaware of how migraine affected patients' lives as a result. It is recommended that HCPs assess impairment using open-ended questions in combination with the ask-tell-ask technique.

Characterizations of Hydrogen Energy Technologies

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

Energetics Inc

2003-04-01

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

Physician activity during outpatient visits and subjective workload.

PubMed

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

2017-05-01

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

Access to Difficult-to-reach Population Subgroups: A Family Midwife Based Home Visiting Service for Implementing Nutrition-related Preventive Activities – A Mixed Methods Explorative Study

PubMed Central

Walz, Helena; Bohn, Barbara; Sander, Jessica; Eberle, Claudia; Alisch, Monika; Oswald, Bernhard; Kroke, Anja

2015-01-01

Health and social inequality are tightly linked and still pose an important public health problem. However, vulnerable and disadvantaged populations are difficult to reach for health-related interventions. Given the long-lasting effects of an adverse, particular nutrition-related, intrauterine and neonatal environment on health development (perinatal programming), an early and easy access is essential for sustainable interventions. The goal of this explorative study was therefore to elucidate whether an existing access of family midwives (FMs) to families in need of support could be an option to implement effective public health and nutrition interventions. To that end three research objectives were formulated: (1) to determine whether a discernible impact of home visits by FMs can be described; (2) to identify subgroups among these families in need of more specific interventions; (3) to determine how relevant nutrition-related topics are for both FMs and the supported families. For addressing these objectives a mixed methods design was used: Routine documentation data from 295 families visited by a family midwife (FM) were analyzed (secondary analysis), and structured expert interviews with FMs were conducted and analyzed. Study reporting followed the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) statement. Based on the FMs reports, a significant improvement (p < 0.001) regarding psycho-social variables could be determined after the home visits. Single mothers, however, seemed to benefit less from the FMs service compared to their counterparts (p = 0.015). Nutritional counseling was demanded by 89% of the families during the home visits. In addition, nutrition-related topics were reported in the interviews to be of high interest to both families and the FMs. Based on the obtained results it is concluded that FMs home visits offer a promising access to vulnerable and disadvantaged families for implementing nutrition-related preventive activities. PMID:29546123

New Roles for Medical Assistants in Innovative Primary Care Practices.

PubMed

Chapman, Susan A; Blash, Lisel K

2017-02-01

To identify and describe new roles for medical assistants (MAs) in innovative care models that improve care while providing training and career advancement opportunities for MAs. Primary data collected at 15 case study sites; 173 key informant interviews and de-identified secondary data on staffing, wages, patient satisfaction, and health outcomes. Researchers used snowball sampling and screening calls to identify 15 organizations using MAs in new roles. Conducted site visits from 2010 to 2012 and updated information in 2014. Thematic analysis explored key topics: factors driving MA role innovation, role description, training required, and wage gains. Categorized outcome data in patient and staff satisfaction, quality of care, and efficiency. New MA roles included health coach, medical scribe, dual role translator, health navigator, panel manager, cross-trained flexible role, and supervisor. Implementation of new roles required extensive training. MA incentives and enhanced compensation varied by role type. New MA roles are part of a larger attempt to reform workflow and relieve primary care providers. Despite some evidence of success, spread has been limited. Key challenges to adoption included leadership and provider resistance to change, cost of additional MA training, and lack of reimbursement for nonbillable services. © Health Research and Educational Trust.

Airport Surface Delays and Causes: A Preliminary Analysis

NASA Technical Reports Server (NTRS)

Chin, David K.; Goldberg, Jay; Tang, Tammy

1997-01-01

This report summarizes FAA Program Analysis and Operations Research Service (ASD-400)/Lockheed Martin activities and findings related to airport surface delays and causes, in support of NASA Langley Research Center's Terminal Area Productivity (TAP) Program. The activities described in this report were initiated in June 1995. A preliminary report was published on September 30, 1995. The final report incorporates data collection forms filled out by traffic managers, other FAA staff, and an airline for the New York City area, some updates, data previously requested from various sources to support this analysis, and further quantification and documentation than in the preliminary report. This final report is based on data available as of April 12, 1996. This report incorporates data obtained from review and analysis of data bases and literature, discussions/interviews with engineers, air-traffic staff, other FAA technical personnel, and airline staff, site visits, and a survey on surface delays and causes. It includes analysis of delay statistics; preliminary findings and conclusions on surface movement, surface delay sources and causes, runway occupancy time (ROT), and airport characteristics impacting surface operations and delays; and site-specific data on the New York City area airports, which are the focus airports for this report.

[Clinical assessment of attention deficit hyperactivity disorder, interview model and controversial issues].

PubMed

Vaquerizo-Madrid, J

2008-01-01

Attention deficit hyperactivity disorder (ADHD) is one of the most frequent reasons for visits to neuropaediatric services. Although the clinical criteria are well established, the medical history is probably not examined with enough care and the most decisive symptoms go unnoticed. AIM. To review a clinical interview model by analysing the first visit of a sample of patients. Our sample consisted of 108 schoolchildren with ADHD whose first visit was to a clinic specialised in hyperactivity and learning difficulties. The most significant data were families' concern about academic achievement, the higher prevalence of the combined subtype of ADHD in girls and age at the visit, with a growing demand for health care during the preschool stage and after the teenage period. The data obtained define a familial scenario or model of ADHD where there is a mixture of the symptoms of the parents, their occupational situation, that of their partner and the ADHD phenotype of the schoolchild we are dealing with. More attention must be paid to the neurodevelopmental period in the preschool stage. Language, which is the most affected area, is the foundation underlying both behaviour and socialisation. Their delayed development, together with the lack of interest in games and clumsiness, is among the features that have been identified for ADHD in small children. Interpreting temperament and explosive behaviour as difficulties hindering social learning is another of the considerations that can be deduced from this clinical research.

Hispanic healthcare disparities: challenging the myth of a monolithic Hispanic population.

PubMed

Weinick, Robin M; Jacobs, Elizabeth A; Stone, Lisa Cacari; Ortega, Alexander N; Burstin, Helen

2004-04-01

Hispanic Americans are often treated as a monolithic ethnic group with a single pattern of healthcare utilization. However, there could be considerable differences within this population. We examine the association between use of healthcare services and Hispanic Americans'country of ancestry or origin, language of interview, and length of time lived in the United States. Our data come from the Medical Expenditure Panel Survey, a nationally representative survey of healthcare use and expenditures. Descriptive statistics and logistic regression results are presented. Multivariate models show that Mexicans and Cubans are less likely, and Puerto Ricans more likely, to have any emergency department visits than non-Hispanic whites. Mexicans, Central American/Caribbeans, and South Americans are less likely to have any prescription medications. All Hispanics are less likely to have any ambulatory visits and prescription medications, whereas only those with a Spanish-language interview are less likely to have emergency department visits and inpatient admissions. More recent immigrants are less likely to have any ambulatory care or emergency department visits, whereas all Hispanics born outside the United States are less likely to have any prescription medications. The Hispanic population is composed of many different groups with diverse health needs and different barriers to accessing care. Misconceptions of Hispanics as a monolithic population lacking within-group diversity could function as a barrier to efforts aimed at providing appropriate care to Hispanic persons and could be 1 factor contributing to inequalities in the availability, use, and quality of healthcare services in this population.

Columbia-Suicide Severity Rating Scale

PubMed Central

Gipson, Polly Y.; Agarwala, Prachi; Opperman, Kiel J.; Horwitz, Adam; King, Cheryl A.

2016-01-01

Objective Despite the high prevalence of psychiatric emergency (PE) visits for attempted suicide and nonsuicidal self-injury (NSSI) among adolescents, we have limited information about assessment tools that are helpful in predicting subsequent risk for suicide attempts among adolescents in PE settings. This study examined the predictive validity of a highly promising instrument, the Columbia-Suicide Severity Rating Scale (C-SSRS). Method Participants were 178 adolescents (44.4% male; ages 13–17 years) seeking PE services. The C-SSRS interview and selected medical chart data were collected for the index visit and subsequent visits during a 1-year follow-up. Results A suicide risk concern was the most common chief complaint (50.6%) in this sample, and nearly one third of the adolescents (30.4%) reported a lifetime history of suicide attempt at index visit. Sixty-two adolescents (34.8%) had at least one return PE visit during follow-up. Lifetime history of NSSI predicted both return PE visits and a suicide attempt at return visit. The C-SSRS intensity scale score was a significant predictor of a suicide attempt at return visit for both the full sample of adolescents and the subsample who reported suicidal ideation at their index visit. In this subsample, one specific item on the intensity scale, duration, was also a significant predictor of both a return PE visit and a suicide attempt at return visit. Conclusions The C-SSRS intensity scale and NSSI had predictive validity for suicide attempts at return visit. Results also suggest that duration of adolescents’ suicidal thoughts may be particularly important to risk for suicidal behavior, warranting further study. PMID:25285389

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

PubMed

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

2005-02-01

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

Eisenhower National Historic Site visitor transportation and access study

DOT National Transportation Integrated Search

2017-11-01

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

Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care

PubMed Central

Hill, Kylie; Goldstein, Roger S.; Guyatt, Gordon H.; Blouin, Maria; Tan, Wan C.; Davis, Lori L.; Heels-Ansdell, Diane M.; Erak, Marko; Bragaglia, Pauline J.; Tamari, Itamar E.; Hodder, Richard; Stanbrook, Matthew B.

2010-01-01

Background People with known risk factors for chronic obstructive pulmonary disease (COPD) are important targets for screening and early intervention. We sought to measure the prevalence of COPD among such individuals visiting a primary care practitioner for any reason. We also evaluated the accuracy of prior diagnosis or nondiagnosis of COPD and identified associated clinical characteristics. Methods We recruited patients from three primary care sites who were 40 years or older and had a smoking history of at least 20 pack-years. Participants were asked about respiratory symptoms and underwent postbronchodilator spirometry. COPD was defined as a ratio of forced expiratory volume in the first second of expiration to forced vital capacity (FEV1/FVC) of less than 0.7 and an FEV1 of less than 80% predicted. Results Of the 1459 patients who met the study criteria, 1003 (68.7%) completed spirometry testing. Of these, 208 were found to have COPD, for a prevalence of 20.7% (95% confidence interval 18.3%–23.4%). Of the 205 participants with COPD who completed the interview about respiratory symptoms before spirometry, only 67 (32.7%) were aware of their diagnosis before the study. Compared with patients in whom COPD had been correctly diagnosed before the study, those in whom COPD had been over-diagnosed or undiagnosed were similar in terms of age, sex, current smoking status and number of visits to a primary care practitioner because of a respiratory problem. Interpretation Among adult patients visiting a primary care practitioner, as many as one in five with known risk factors met spirometric criteria for COPD. Underdiagnosis of COPD was frequent, which suggests a need for greater screening of at-risk individuals. Knowledge of the prevalence of COPD will help plan strategies for disease management. PMID:20371646

How does specialist nursing contribute to HIV service delivery across England?

PubMed

Piercy, Hilary; Bell, Gill; Hughes, Charlie; Naylor, Simone; Bowman, Christine A

2017-07-01

This study aimed to examine what specialist nursing contributes to HIV service delivery across England and how it could be optimised. A three part multi-method qualitative study was undertaken, involving (1) interviews with 19 stakeholders representing professional or service user groups; (2) interviews with nurse/physician pairs from 21 HIV services; and (3) case studies involving site visits to five services. A framework analysis approach was used to manage and analyse the data. There was substantial variability in specialist nursing roles and the extent of role development. Most hospital-based HIV nurses (13/19) were running nurse-led clinics, primarily for stable patients with almost half (6/13) also managing more complex patients. Role development was supported by non-medical prescribing, a robust governance framework and appropriate workload allocation. The availability and organisation of community HIV nursing provision determined how services supported vulnerable patients to keep them engaged in care. Four service models were identified. The study showed that there is scope for providing a greater proportion of routine care through nurse-led clinics. HIV community nursing can influence health outcomes for vulnerable patients, but provision is variable. With limited financial resources, services may need to decide how to deploy their specialist nurses for best effect.

Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities.

PubMed

McHugh, John P; Foster, Andrew; Mor, Vincent; Shield, Renée R; Trivedi, Amal N; Wetle, Terrie; Zinn, Jacqueline S; Tyler, Denise A

2017-09-01

Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries' costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a concurrent mixed-methods approach, combining Medicare claims data for the period 2009-13 with qualitative data gathered from interviews during site visits to hospitals in eight US markets in March-October 2015, to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal SNF networks. Four hospitals had developed formal SNF networks as part of their care management efforts. These hospitals saw a relative reduction from 2009 to 2013 in readmission rates for patients discharged to SNFs that was 4.5 percentage points greater than the reduction for hospitals without formal networks. Interviews revealed that those with networks expanded existing relationships with SNFs, effectively managed patient data, and exercised a looser interpretation of patient choice. Project HOPE—The People-to-People Health Foundation, Inc.

Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities

PubMed Central

Foster, Andrew; Mor, Vincent; Shield, Renée R.; Trivedi, Amal N.; Wetle, Terrie; Zinn, Jacqueline S.; Tyler, Denise A.

2017-01-01

Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries’ costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a concurrent mixed-methods approach, combining Medicare claims data for the period 2009–13 with qualitative data gathered from interviews during site visits to hospitals in eight US markets in March–October 2015, to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal SNF networks. Four hospitals had developed formal SNF networks as part of their care management efforts. These hospitals saw a relative reduction from 2009 to 2013 in readmission rates for patients discharged to SNFs that was 4.5 percentage points greater than the reduction for hospitals without formal networks. Interviews revealed that those with networks expanded existing relationships with SNFs, effectively managed patient data, and exercised a looser interpretation of patient choice. PMID:28874486

Hospitals Negotiating Leverage with Health Plans: How and Why Has It Changed?

PubMed Central

Devers, Kelly J; Casalino, Lawrence P; Rudell, Liza S; Stoddard, Jeffrey J; Brewster, Linda R; Lake, Timothy K

2003-01-01

Objective To describe how hospitals' negotiating leverage with managed care plans changed from 1996 to 2001 and to identify factors that explain any changes. Data Sources Primary semistructured interviews, and secondary qualitative (e.g., newspaper articles) and quantitative (i.e., InterStudy, American Hospital Association) data. Study Design The Community Tracking Study site visits to a nationally representative sample of 12 communities with more than 200,000 people. These 12 markets have been studied since 1996 using a variety of primary and secondary data sources. Data Collection Methods Semistructured interviews were conducted with a purposive sample of individuals from hospitals, health plans, and knowledgeable market observers. Secondary quantitative data on the 12 markets was also obtained. Principal Findings Our findings suggest that many hospitals' negotiating leverage significantly increased after years of decline. Today, many hospitals are viewed as having the greatest leverage in local markets. Changes in three areas—the policy and purchasing context, managed care plan market, and hospital market—appear to explain why hospitals' leverage increased, particularly over the last two years (2000–2001). Conclusions Hospitals' increased negotiating leverage contributed to higher payment rates, which in turn are likely to increase managed care plan premiums. This trend raises challenging issues for policymakers, purchasers, plans, and consumers. PMID:12650374

Stakeholder Participation in System Change: A New Conceptual Model.

PubMed

O'Rourke, Tammy; Higuchi, Kathryn S; Hogg, William

2016-08-01

A recent change in Canada's primary care system led to the introduction of Nurse Practitioner-Led clinics. The literature suggests that stakeholders can influence system change initiatives. However, very little is known about healthcare stakeholder motivations, particularly stakeholders who are seen as resistors to change. To examine stakeholder participation in the system change process that led to the introduction of the first Nurse Practitioner-Led clinic in Ontario. This single case study included two site visits, semistructured individual tape-recorded interviews, and the examination of relevant public documents. Qualitative content analysis was used to analyze the data. Sixteen individuals from different healthcare sectors and professions participated in the interviews and 20 documents were reviewed. Six key themes emerged from the data. Linking Evidence to Action The findings from the study present a new perspective on stakeholder participation that includes both those who supported the proposed change and those who advocated for a different change. The findings identify stakeholder activities used to shape, share, and protect their visions for system change. The conceptual model presented in this study adds to the understanding of challenges and complexities involved in healthcare system change. Understanding why and how stakeholders participate in change can help healthcare leaders in planning activities to enhance stakeholder involvement in healthcare system change. © 2016 Sigma Theta Tau International.

Can the care transitions measure predict rehospitalization risk or home health nursing use of home healthcare patients?

PubMed

Ryvicker, Miriam; McDonald, Margaret V; Trachtenberg, Melissa; Peng, Timothy R; Sridharan, Sridevi; Feldman, Penny H

2013-01-01

The Care Transitions Measure (CTM) was designed to assess the quality of patient transitions from the hospital. Many hospitals are using the measure to inform their efforts to improve transitional care. We sought to determine if the measure would have utility for home healthcare providers by predicting newly admitted patients at heightened risk for emergency department use, rehospitalization, or increased home health nursing visits. The CTM was administered to 495 home healthcare patients shortly after hospital discharge and home healthcare admission. Follow-up interviews were completed 30 and 60 days post hospital discharge. Interview data were supplemented with agency assessment and service use data. We did not find evidence that the CTM could predict home healthcare patients having an elevated risk for emergent care, rehospitalization, or higher home health nursing use. Because Medicare/Medicaid-certified home healthcare providers already use a comprehensive, mandated start of care assessment, the CTM may not provide them additional crucial information. Process and outcome measurement is increasingly becoming part of usual care. Selection of measures appropriate for each service setting requires thorough site-specific evaluation. In light of our findings, we cannot recommend the CTM as an additional measure in the home healthcare setting. © 2013 National Association for Healthcare Quality.

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

PubMed

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

2018-06-05

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

Leaders in cell adhesion: an interview with Richard Hynes, pioneer of cell-matrix interactions. Interview by Pamela Cowin.

PubMed

Hynes, Richard

2013-12-01

On a recent visit Richard O Hynes, FRS, HHMI, Daniel K. Ludwig Professor for Cancer Research at the Koch Institute for Integrative Cancer Research, MIT, graciously agreed to be interviewed in person for the first in Cell Communication and Adhesion's series on "Leaders in Cell Adhesion". In this interview we discussed three things: 1) the early role of family, mentors, and luck on his career path; 2) his major discoveries of fibronectin, integrins and the evolution of extracellular matrix proteins; and 3) his role in, and thoughts on, current science policy. This interview reveals his characteristic calmness and infectious optimism, his spontaneous and down to earth sense of humor, and his great ability to place scientific questions in perspective. The interview, carried out on April 30(th) 2013 is reported here verbatim with only minor editing for clarity.

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

ERIC Educational Resources Information Center

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

2002-01-01

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

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

Treesearch

Cassandra Y. Johnson; J. Michael Bowker

1999-01-01

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

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

PubMed

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

2018-05-01

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

Assessing the oral health of an ageing population: methods, challenges and predictors of survey participation.

PubMed

Matthews, Debora C; Brillant, Martha G S; Clovis, Joanne B; McNally, Mary E; Filiaggi, Mark J; Kotzer, Robert D; Lawrence, Herenia P

2012-06-01

To examine predictors of participation and to describe the methodological considerations of conducting a two-stage population-based oral health survey. An observational, cross-sectional survey (telephone interview and clinical oral examination) of community-dwelling adults aged 45-64 and ≥65 living in Nova Scotia, Canada was conducted. The survey response rate was 21% for the interview and 13.5% for the examination. A total of 1141 participants completed one or both components of the survey. Both age groups had higher levels of education than the target population; the age 45-64 sample also had a higher proportion of females and lower levels of employment than the target population. Completers (participants who completed interview and examination) were compared with partial completers (who completed only the interview), and stepwise logistic regression was performed to examine predictors of completion. Identified predictors were as follows: not working, post-secondary education and frequent dental visits. Recruitment, communications and logistics present challenges in conducting a province-wide survey. Identification of employment, education and dental visit frequency as predictors of survey participation provide insight into possible non-response bias and suggest potential for underestimation of oral disease prevalence in this and similar surveys. This potential must be considered in analysis and in future recruitment strategies. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

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

NASA Astrophysics Data System (ADS)

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

2005-12-01

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

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

PubMed

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

2013-12-01

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

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

PubMed Central

2013-01-01

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

Patterns of primary care utilization before and after living kidney donation.

PubMed

Alejo, Jennifer L; Luo, Xun; Massie, Allan B; Henderson, Macey L; DiBrito, Sandra R; Locke, Jayme E; Purnell, Tanjala S; Boyarsky, Brian J; Anjum, Saad; Halpern, Samantha E; Segev, Dorry L

2017-07-01

Annual visits with a primary care provider (PCP) are recommended for living kidney donors to monitor long-term health postdonation, yet adherence to this recommendation is unknown. We surveyed 1170 living donors from our center from 1970 to 2012 to ascertain frequency of PCP visits pre- and postdonation. Interviews occurred median (IQR) 6.6 (3.8-11.0) years post-transplant. We used multivariate logistic regression to examine associations between donor characteristics and PCP visit frequency. Overall, only 18.6% had less-than-annual PCP follow-up postdonation. The strongest predictor of postdonation PCP visit frequency was predonation PCP visit frequency. Donors who had less-than-annual PCP visits before donation were substantially more likely to report less-than-annual PCP visits postdonation (OR= 9.8 14.4 21.0, P<.001). Men were more likely to report less-than-annual PCP visits postdonation (adjusted OR= 1.2 1.6 2.3, P<.01); this association was amplified in unmarried/noncohabiting men (aOR= 2.4 3.9 6.3, P<.001). Donors without college education were also more likely to report less-than-annual PCP visits postdonation (aOR= 1.3 1.8 2.5 , P=.001). The importance of annual PCP visits should be emphasized to all living donors, especially those with less education, men (particularly single men), and donors who did not see their PCP annually before donation. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

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

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

Evidence based practice in clinical physiotherapy education: a qualitative interpretive description

PubMed Central

2013-01-01

Background Health care undergraduate students are expected to practice evidence-based after they graduate. Previous research indicates that students face several problems with transferring evidence-based practice to real patient situations. Few studies have explored reasons for this. The aim of this study was to explore beliefs, experiences and attitudes related to third year students’ use of evidence-based practice in clinical physiotherapy education among students, clinical instructors and visiting teachers. Methods In total, six focus group interviews were conducted: three with 16 students, two with nine clinical instructors and one with four visiting teachers. In addition, one individual interview and one interview in a pair were conducted with clinical instructors. Interviewing three different participant-categories ensured comparative analysis and enabled us to exploit differences in perspectives and interactions. Interpretive description guided this process. Results Four integrative themes emerged from the analysis: “attempt to apply evidence-based practice”, “novices in clinical practice”, “prioritize practice experience over evidence-based practice” and “lack role models in evidence-based practice”. Students tried to search for research evidence and to apply this knowledge during clinical placements; a behaviour that indicated a positive attitude towards evidence-based practice. At the same time, students were novices and required basic background information more than research information. As novices they tended to lean on their clinical instructors, and were more eager to gain practical experience than practicing evidence-based; a behaviour that clinical instructors and visiting teachers often supported. Students noticed a lack of an EBP culture. Both students and clinical instructors perceived a need for role models in evidence-based practice. Conclusions Clinical instructors are in a position to influence students during clinical education, and thus, important potential role models in evidence-based practice. Actions from academic and clinical settings are needed to improve competence in evidence-based practice among clinical instructors, and future research is needed to investigate the effect of such efforts on students’ behaviour. PMID:23578211

Evidence based practice in clinical physiotherapy education: a qualitative interpretive description.

PubMed

Olsen, Nina R; Bradley, Peter; Lomborg, Kirsten; Nortvedt, Monica W

2013-04-11

Health care undergraduate students are expected to practice evidence-based after they graduate. Previous research indicates that students face several problems with transferring evidence-based practice to real patient situations. Few studies have explored reasons for this. The aim of this study was to explore beliefs, experiences and attitudes related to third year students' use of evidence-based practice in clinical physiotherapy education among students, clinical instructors and visiting teachers. In total, six focus group interviews were conducted: three with 16 students, two with nine clinical instructors and one with four visiting teachers. In addition, one individual interview and one interview in a pair were conducted with clinical instructors. Interviewing three different participant-categories ensured comparative analysis and enabled us to exploit differences in perspectives and interactions. Interpretive description guided this process. Four integrative themes emerged from the analysis: "attempt to apply evidence-based practice", "novices in clinical practice", "prioritize practice experience over evidence-based practice" and "lack role models in evidence-based practice". Students tried to search for research evidence and to apply this knowledge during clinical placements; a behaviour that indicated a positive attitude towards evidence-based practice. At the same time, students were novices and required basic background information more than research information. As novices they tended to lean on their clinical instructors, and were more eager to gain practical experience than practicing evidence-based; a behaviour that clinical instructors and visiting teachers often supported. Students noticed a lack of an EBP culture. Both students and clinical instructors perceived a need for role models in evidence-based practice. Clinical instructors are in a position to influence students during clinical education, and thus, important potential role models in evidence-based practice. Actions from academic and clinical settings are needed to improve competence in evidence-based practice among clinical instructors, and future research is needed to investigate the effect of such efforts on students' behaviour.

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

PubMed

Burkle, Christopher M; Keegan, Mark T

2015-09-26

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

Proceedings of the scientific visit on crystalline rock repository development.

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

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

2013-02-01

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

D Modelling and Mapping for Virtual Exploration of Underwater Archaeology Assets

NASA Astrophysics Data System (ADS)

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

2017-02-01

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

Visits to Registered Nurses

PubMed Central

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

2017-01-01

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

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

PubMed

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

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

Bradbury

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

Daily Life or Diagnosis? Dual Perspectives on Perinatal Depression within Maternal and Child Health Home Visiting

PubMed Central

Price, Sarah Kye; Cohen-Filipic, Katherine

2013-01-01

This study describes a qualitative inquiry–informing program development in a maternal and child home visiting program. Low-income women's perceptions of the meaning and experiences of depression were ascertained through focus groups and interviews. Simultaneously, the study examines staff member perceptions and roles related to depression. Specific findings from clients and staff reveal culturally situated beliefs about depression and stressful life events; comparing and contrasting these beliefs offers a novel perspective on identification and intervention for maternal depression. This study offers a foundation for a translational research agenda that will be used for program and policy development to enhance mental health services situated within maternal and child health home visiting programs. PMID:23944165

Mississippi lieutenant governor visits Stennis

NASA Image and Video Library

2009-10-01

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

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

PubMed

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

2018-04-16

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

Satellite communications systems and technology. Executive Summary

NASA Technical Reports Server (NTRS)

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

1993-01-01

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

Client and Provider Perspectives of the Efficiency and Quality of Care in the Context of Rapid Scale-Up of Antiretroviral Therapy

PubMed Central

Wanyenze, Rhoda; Alamo, Stella; Kwarisiima, Dalsone; Sunday, Pamela; Sebikaari, Gloria; Kamya, Moses; Wabwire-Mangen, Fred; Wagner, Glenn

2010-01-01

Abstract Global scale-up of antiretroviral therapy (ART) has focused on clinical outcomes with little attention on its impact on existing health systems. In June–August 2008, we conducted a formative evaluation on ART scale-up and clinic operations at three clinics in Uganda to generate lessons for informing policy and larger public health care systems. Site visits and semistructured interviews with 10 ART clients and 6 providers at each clinic were used to examine efficiency of clinic operations (patient flow, staff allocation to appropriate duties, scheduling of clinic visits, record management) and quality of care (attending to both client and provider needs, and providing support for treatment adherence and retention). Clients reported long waiting times but otherwise general satisfaction with the quality of care. Providers reported good patient adherence and retention, and support mechanisms for clients. Like clients, providers mentioned long waiting times and high workload as major challenges to clinic expansion. Providers called for more human resources and stress-release mechanisms to prevent staff burnout. Both providers and clients perceive these clinics to be delivering good quality care, despite the recognition of congested clinics and long waiting times. These findings highlight the need to address clinic efficiency as well as support for providers in the context of rapid scale-up. PMID:21034243

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

NASA Astrophysics Data System (ADS)

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

2017-12-01

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

Rapid assessment of infant feeding support to HIV-positive women accessing prevention of mother-to-child transmission services in Kenya, Malawi and Zambia.

PubMed

Chopra, Mickey; Doherty, Tanya; Mehatru, Saba; Tomlinson, Mark

2009-12-01

The possibility of mother-to-child transmission (MTCT) of HIV through breast-feeding has focused attention on how best to support optimal feeding practices especially in low-resource and high-HIV settings, which characterizes most of sub-Saharan Africa. To identify strategic opportunities to minimize late postnatal HIV transmission, we undertook a review of selected country experiences on HIV and infant feeding, with the aims of documenting progress over the last few years and determining the main challenges and constraints. Field teams conducted national-level interviews with key informants and visited a total of thirty-six facilities in twenty-one sites across the three countries--eighteen facilities in Malawi, eleven in Kenya and seven in Zambia. During these visits interviews were undertaken with key informants such as the district and facility management teams, programme coordinators and health workers. A rapid assessment of HIV and infant feeding counselling in Kenya, Malawi and Zambia, undertaken from February to May 2007. Infant feeding counselling has, until now, been given low priority within programmes aimed at prevention of MTCT (PMTCT) of HIV. This is manifest in the lack of resources - human, financial and time--for infant feeding counselling, leading to widespread misunderstanding of the HIV transmission risks from breast-feeding. It has also resulted in lack of space and time for proper counselling, poor support and supervision, and very weak monitoring and evaluation of infant feeding. Finally, there are very few examples of linkages with community-based infant feeding interventions. However, all three countries have started to revise their feeding policies and strategies and there are signs of increased resources. In order to sustain this momentum it will be necessary to continue the advocacy with the HIV community and stress the importance of child survival--not just minimization of HIV transmission - and hence the need for integrating MTCT prevention.

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

ERIC Educational Resources Information Center

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

2013-01-01

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

"My child can't keep anything down!" Interviewing parents who bring their preschoolers to the emergency department for diarrhea, vomiting, and dehydration.

PubMed

Graham, Jennifer M; Fitzpatrick, Eleanor A; Black, Karen J L

2010-04-01

Viral gastroenteritis with dehydration is one of the most frequent reasons for visits to pediatric emergency departments (ED). Parental intervention before presentation to the ED can make a significant difference in the course of a child's illness. There is a discrepancy between medical knowledge of dehydration and parental fears and understanding. This project is part of a larger program of research developing an educational tool for parents of preschoolers with diarrhea, vomiting, and dehydration. The primary objective was to develop an interview guide. From initial data, the researchers explored parental motivations for bringing their children to the ED. Ten families were recruited after their visit to a pediatric ED in the fall of 2007. Included were families of children younger than 4 years who experienced vomiting, diarrhea, and dehydration. Interviews were conducted over the telephone and were transcribed. The interview guide was edited in an iterative process. Thematic analysis focused on parents' decision to take their child to the ED. Making the decision to take a child to the ED is a complex process for parents. This decision involves expectations developed from community-level, family-level, and child factors. Issues of access to care affect parents' decision, including perceived level of urgency, travel time, and modes of transport available. A framework is proposed, which outlines the most important factors our sample of parents reported when deciding whether to take their ill child to the ED. The interview guide developed will facilitate collection of further information.

World Presidents Organization

NASA Technical Reports Server (NTRS)

2010-01-01

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