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.

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…

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…

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...

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.

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.

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.

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 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...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-29

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

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

ERIC Educational Resources Information Center

1996

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

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,...

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...

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)

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.

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

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

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.

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…

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

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.

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.

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.

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...

Effects of Site Visits on Innovation Adoption.

ERIC Educational Resources Information Center

Fleischer, Mitchell

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

Privacy Policy | NOAA Gulf Spill Restoration

Science.gov Websites

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

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.

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.

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.

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...

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.

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.

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

PubMed

Appleton, Jane V; Cowley, Sarah

2008-02-01

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

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.

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

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.

Case Studies of Selected Cooperative Adult Education Programs.

ERIC Educational Resources Information Center

Moore, Allen B., Ed.; And Others

Third in a series of five, the document presents case study reports of site visits to cooperative adult education programs. The five locations visited included programs between: (1) Wharton County Junior College and Johnson Testers, Inc. (Texas); (2) Louisiana State Department of Education and B. F. Trappey and Sons (Louisiana); (3) Grand Rapids…

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.

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

PubMed Central

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

2015-01-01

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

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.

Detection of new HIV infections in a multicentre HIV antiretroviral pre-exposure prophylaxis trial.

PubMed

Fransen, Katrien; de Baetselier, Irith; Rammutla, Elizabeth; Ahmed, Khatija; Owino, Frederick; Agingu, Walter; Venter, Gustav; Deese, Jen; Van Damme, Lut; Crucitti, Tania

2017-08-01

Monthly specimens collected from FEM-PrEP-a Phase III trial [1] were investigated for the detection of acute HIV (AHI) infection. To evaluate the efficiency of the study-specific HIV algorithm in detecting AHI, and the performance of each of the serological and molecular tests used in diagnosing new infections, and their contribution to narrowing the window period. A total of 83 pre-seroconversion specimens from 61 seroconverters from the FEM-PrEP trial were further analyzed in a sub-study. During the trial, HIV seroconversion was diagnosed on site using a testing algorithm with simple/rapid tests (SRTs) and confirmed with a gold standard testing algorithm (see short communication: Fig. 1). The infection date was determined more accurately by the use of standard ELISAs and Nucleic Acid Amplification Tests (NAAT) in a look-back procedure. For this sub-study, the international central laboratory repeated the study algorithm using SRTs. A total of 83 pre-seroconversions specimens from 61 seroconverters were analyzed in a look-back procedure. RNA was detected in 35/61 seroconverters at the visit before the seroconversion visit as determined at the study sites. Four seroconversion dates were inaccurate at one study site as the international central laboratory detected the HIV infection one visit earlier using the same test algorithm. Using the gold standard, an additional seroconversion was detected at an earlier visit. The combined antigen/antibody and the single antigen test had a higher sensitivity compared to the SRTs in detecting acute infections. In the FEM-PrEP trial, the international central laboratory detected a small number of seroconversions one month earlier than the study sites using the same study algorithm. Standard tests are still the most sensitive tests in detecting pre-seroconversion or acute HIV infection, but they are costly, time consuming and not recommended for use on-site in a clinical trial. Copyright © 2017 Elsevier B.V. All rights reserved.

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.

Flowers visited by hummingbirds in the open habitats of the southeastern Brazilian mountaintops: species composition and seasonality.

PubMed

Rodrigues, L C; Rodrigues, M

2014-08-01

The hummingbird-visited plant community located on the open-habitat mountaintop of the Espinhaço Range was studied for two years (from August 2007 to July 2009) in Serra do Cipó National Park, Southeastern Brazil (19° 15' S and 43° 31' W). The floral characteristics and flowering period of the hummingbird-visited plants was monthly recorded along trails located in three vegetation types: (1) typical campos rupestres (TCR), (2) open fields (OPF), and (3) capões de mata (CAM). Hummingbird visitation was observed in 51 plant species, 22 ornithophilous and 29 non-ornithophilous species. The TCR showed the greatest number of species visited (N = 38), followed by the OPF (N = 18) and CAM (N = 17). Six species of hummingbirds were recorded visiting flowers: Augastes scutatus, Campylopterus largipennis, Colibri serrirostris, Chlorostilbon lucidus, Eupetomena macroura and Phaethornis pretrei. This study demonstrates that the species richness and the number of ornithophilous species visited by the hummingbirds at the study site are more similar to hummingbird-plant communities of the Atlantic Forest than to those of the Cerrado communities and other Brazilian highland open-habitat communities. The plant families most visited by hummingbirds were Bromeliaceae and Asteraceae. Although the Asteraceae family is rarely used as a food resource for hummingbirds in other high and lowland communities, in the study site this family is used mainly by the endemic hummingbird Augastes scutatus. We found a large overlap of flowering throughout the year among the species visited by the hummingbirds. Thus, the nectar availability supports these resident hummingbirds. The present study also showed that the studied hummingbird-plant community is composed of many species endemic to the campos rupestres of the Espinhaço Range, some of which are considered to be in danger of extinction, thus constituting a unique and threatened community. Thus, understanding hummingbird-plant pollination dynamics becomes fundamental to the conservation of the campos rupestres.

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.

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).

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.

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

PubMed

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

2013-08-21

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

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.

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,…

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

PubMed

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

2009-01-01

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

7 CFR 3015.94 - Site visits.

Code of Federal Regulations, 2010 CFR

2010-01-01

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

Father Attendance in Nurse Home Visitation

PubMed Central

Holmberg, John R.; Olds, David L.

2015-01-01

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

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.

An exploration of visitor motivations: The search for silence

NASA Astrophysics Data System (ADS)

Marin, Lelaina D.

2011-12-01

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

Trip experiences and tourists' motivation

Treesearch

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

1998-01-01

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

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

PubMed

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

2012-04-01

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

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

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

Treesearch

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

2002-01-01

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

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

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

ERIC Educational Resources Information Center

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

2012-01-01

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

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

PubMed

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

2007-12-01

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

Weir Farm National Historic Site : alternative transportation feasibility study

DOT National Transportation Integrated Search

2012-07-31

This report provides an assessment of the feasibility of alternative transportation options to accommodate visitation at Weir Farm National Historic Site in Ridgefield, Connecticut. Weir Farm, the historic home of artist J. Alden Weir, faces numerous...

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

PubMed

Dupont, Yoko L; Olesen, Jens M

2009-03-01

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

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

PubMed

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

2001-10-08

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

A Study of Operator and Mechnaic Training Needs in the Transit Industry. Volume II, Appendices. Final Report.

ERIC Educational Resources Information Center

Henderson, Harold L.; And Others

Surveys of 188 transit properties and on-site visits were conducted to determine the training needs of operators and mechanics in the urban mass transportation industry. The appendices include listings of respondents and sample copies of the survey questionnaires and visit reports. (NTIS)

SOLVENT-BASED TO WATERBASED ADHESIVE-COATED SUBSTRATE RETROFIT - VOLUME IV: FILM AND LABEL MANUFACTURING CASE STUDY: FLEXCON COMPANY, INC.

EPA Science Inventory

This volume discusses a visit to a site operated by FLEXcon Company, Inc., a pressure-sensitive adhesive coater, to collect information on the pollution prevention opportunities and barriers associated with waterbased adhesives. The purpose of the visit to FLEXcon was to gather i...

Business Administration and Management: Current Trends and Future Directions.

ERIC Educational Resources Information Center

Flewellen, William C., Jr.

Drawing from site visits to 39 public and private colleges in Massachusetts, this report presents an evaluation of college programs in business administration and management and recommendations for improvement. Section 1 provides an overview of the statewide study and its findings. After identifying the colleges visited and the members of the…

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…

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.

Information and communication technology

NASA Technical Reports Server (NTRS)

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

1994-01-01

NASA and the National Science Foundation (NSF) commissioned a panel of U.S. experts to study the international status of satellite communications systems and technology. The study covers emerging systems concepts, applications, services, and the attendant technologies. The panel members traveled to Europe, Japan, and Russia to gather information firsthand. They visited 17 sites in Europe, 20 in Japan, and 4 in Russia. These included major manufacturers, government organizations, service providers, and associated research and development facilities. The panel's report was reviewed by the sites visited, by the panel, and by representatives of U.S. industry. The report details the information collected and compares it to U.S. activities.

Crozer-Chester Medical Center Burn Research Project

DTIC Science & Technology

2010-07-18

2010, but unfortunately needed to be cancelled by the Army. We are attempting to reschedule this visit. Study 2 (Donor Site Study): Enrollment... Nurse makes daily rounds on the burn unit to identify possible candidates for the study. Due to the limits of the eligibility criteria, enrollment...2009 – Sept 2009: Study #2 – Donor Site Study continues. The Burn Research Nurse completes daily rounds to identify patients for the donor site study

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 affecting yearly and monthly visits to Taipei Zoo

NASA Astrophysics Data System (ADS)

Su, Ai-Tsen; Lin, Yann-Jou

2018-02-01

This study investigated factors affecting yearly and monthly numbers of visits to Taipei Zoo. Both linear and nonlinear regression models were used to estimate yearly visits. The results of both models showed that the "opening effect" and "animal star effect" had a significantly positive effect on yearly visits, while a SARS outbreak had a negative effect. The number of years had a significant influence on yearly visits. Results showed that the nonlinear model had better explanatory power and fitted the variations of visits better. Results of monthly model showed that monthly visits were significantly influenced by time fluctuations, weather conditions, and the animal star effect. Chinese New Year, summer vacation, numbers of holidays, and animal star exhibitions increased the number of monthly visits, while the number of days with temperatures at or below 15 °C, the number of days with temperatures at or above 30 °C, and the number of rainy days had significantly negative effects. Furthermore, the model of monthly visits showed that the animal star effect could last for over two quarters. The results of this study clarify the factors affecting visits to an outdoor recreation site and confirm the importance of meteorological factors to recreation use.

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

PubMed Central

2013-01-01

Background Earaches and outer ear infections are commonly associated with swimming. In this study, we estimated the excess risk and health burden of earaches due to swimming in natural fresh and marine waters using results from a survey of over 50,000 beachgoers at nine beaches across the United States. Methods Prospective cohort studies were conducted at four freshwater and five marine sites in the United States and Puerto Rico. Beach visitors were enrolled on summer weekends and holidays. Ten to twelve days after the beach visit, respondents answered questions about health symptoms, including earaches or ear infections experienced since the beach visit. Economic and physical burdens were also obtained. Fixed slope, random intercept (beach site) multivariate logistic regression models were used to estimate the relationship between head immersion swimming exposure and earaches. Model results were used to calculate excess risk for earaches attributable to swimming. Results The overall incidence of self-reported earache was 1.6% in the 10–12 days after the beach visit. Earaches were more frequent in head immersion swimmers compared to non-swimmers for all beach sites and age groups. Earaches were unassociated with water sample measures of fecal contamination and turbidity. After adjustment for covariates, we calculated 7.12 excess earaches among head immersion swimmers per 1,000 swimming events. Twenty-four percent of those with earache reported missing their regular activities; 28% visited a doctor; 4% visited the emergency room; and 31% and 40% used prescription and non-prescription medications, respectively. Conclusions There are at least 128 million swimming events in natural waters annually. Such frequent exposures could result in 900,000 excess earaches, 260,000 visits to the doctor, 39,900 visits to the emergency room, nearly $4 million dollars in out-of-pocket expenditures on prescription and over-the-counter medications, and close to 75,000 hours of clinician time. More accurate estimates of swimming exposure are needed to improve population burden and associated cost estimates. PMID:23962340

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…

Perceived Value of Educational Hypermedia: An Exploratory Study

ERIC Educational Resources Information Center

Gao, Yuan; Wu, Xiaoyu

2010-01-01

This paper explores the idea of perceived value of educational hypermedia by extending prior research in advertising and information systems. It proposes that the value of a course support site comes from both its information content and users' experience when they visit the site. The cognitive antecedents of a site's perceived value include…

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

Early return visits by primary care patients: a retail nurse practitioner clinic versus standard medical office care.

PubMed

Rohrer, James E; Angstman, Kurt B; Garrison, Gregory

2012-08-01

The purpose of this study was to compare return visits made by patients within 2 weeks after using retail nurse practitioner clinics to return visits made by similar patients after using standard medical office clinics. Retail medicine clinics have become widely available. However, their impact on return visit rates compared to standard medical office visits for similar patients has not been extensively studied. Electronic medical records of adult primary care patients seen in a large group practice in Minnesota in 2009 were analyzed for this study. Patients who were treated for sinusitis were selected. Two groups of patients were studied: those who used one of 2 retail walk-in clinics staffed by nurse practitioners and a comparison group who used one of 4 regular office clinics. The dependent variable was a return office visit to any site within 2 weeks. Multiple logistic regression analysis was used to adjust for case-mix differences between groups. Unadjusted odds of return visits were lower for retail clinic patients than for standard office care patients. After adjustment for case mix, patients with more outpatient visits in the previous 6 months had higher odds of return visits within 2 weeks (2-6 prior visits: odds ratio [OR]=1.99, P=0.00; 6 or more prior visits: OR=6.80, P=0.00). The odds of a return visit within 2 weeks were not different by clinic type after adjusting for propensity to use services (OR=1.17, P=0.28). After adjusting for case mix differences, return visit rates did not differ by clinic type.

Factors affecting the value of a wilderness visit: a contingent valuation study of Caribou-Speckled Mountain Wilderness users

Treesearch

Jeffery A. Michael; Stephen Reiling; Hsiang-Tai Cheng

1995-01-01

A dichotomous choice contingent valuation model is estimated using an on-site survey of Caribou-Speckled Mountain Wilderness visitors. The results indicate that pre-trip expectations of various trip attributes such as congestion have a greater impact on a trip?s value than the actual conditions of the visit. This research also shows that future economic studies of an...

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

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.

The Peculiar Institution?: A Multisite Case Study of Athletic Department Cultures at Small Christian Institutions

ERIC Educational Resources Information Center

Ramseyer, Paul Robert

2017-01-01

This multisite case study explored the perceptions of athletic department members of the important factors of organizational cultures in athletic departments at small Christian institutions in the Midwestern United States. The study comprised of site visits to three small Christian institutions in the Midwestern United States. At each site, six…

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.

Study of the impact on Salmonella of moving outdoor pigs to fresh land.

PubMed

Smith, R P; Andres, V; Dormer, L; Gosling, R; Oastler, C; Davies, R H

2017-07-01

Anecdotal evidence has suggested that outdoor-kept pigs show an improvement to health and productivity after being moved to a new site. This study explores whether Salmonella occurrence reduced and was sustained after moving to a new site. Nine farms were followed for a year in which four sampling visits were completed. The highest detection of Salmonella was from pooled faecal dropping from pigs, run-off/ pooled water, rodents and wild birds. Descriptive summaries showed that the prevalence of both all Salmonella and serovars of public health importance were lower at all visits after the move. Some variability was shown in results from individual farms, but a year after the move, six farms still maintained a lower prevalence. A risk factor model showed that the prevalence at visits 2 and 3 after the move was significantly lower than baseline, after accounting for a number of significant factors that were included in the model. These were sample type and seasonality (included as a priori), presence of coughing in the sampled group and Glasser's disease on the farm, and the use of tent or kennel accommodation. This finding provides important evidence that more frequent site moves may help reduce Salmonella prevalence in outdoor herds.

Self-guided field trips for students of environments

NASA Astrophysics Data System (ADS)

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

2011-05-01

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

Web Analytics: A Picture of the Academic Library Web Site User

ERIC Educational Resources Information Center

Black, Elizabeth L.

2009-01-01

This article describes the usefulness of Web analytics for understanding the users of an academic library Web site. Using a case study, the analysis describes how Web analytics can answer questions about Web site user behavior, including when visitors come, the duration of the visit, how they get there, the technology they use, and the most…

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

EPA Pesticide Factsheets

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

76 FR 4919 - Regulatory Site Visit Training Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-27

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

75 FR 6404 - Regulatory Site Visit Training Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-09

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

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

PubMed

Roubik, D W; Ackerman, J D

1987-09-01

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

Environmental Field Trips - Some Places to Visit in Maryland, Virginia and the District of Columbia.

ERIC Educational Resources Information Center

Meetre, Jeff

This publication lists 40 places in the metropolitan Washington, D.C. area that could be visited on an environmental field trip. The sites are placed into five categories: (1) Air Monitoring; (2) Ecology and Nature Study; (3) Solid Waste Management; (4) Wastewater Treatment; and (5) Water Supply. Each entry includes name, address, and phone number…

Randomized Trial of a Statewide Home Visiting Program: Impact in Preventing Child Abuse and Neglect

ERIC Educational Resources Information Center

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

2004-01-01

Objectives: To assess the impact of home visiting in preventing child abuse and neglect in the first 3 years of life in families identified as at-risk of child abuse through population-based screening at the child's birth. Methods: This experimental study focused on Hawaii Healthy Start Program (HSP) sites operated by three community-based…

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

PubMed

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

2012-03-01

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

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.

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.

Potential for gulls to transport bacteria from human waste sites to beaches.

PubMed

Alm, Elizabeth W; Daniels-Witt, Quri R; Learman, Deric R; Ryu, Hodon; Jordan, Dustin W; Gehring, Thomas M; Santo Domingo, Jorge

2018-02-15

Contamination of recreational beaches due to fecal waste from gulls complicates beach monitoring and may pose a risk to public health. Gulls that feed at human waste sites may ingest human fecal microorganisms associated with that waste. If these gulls also visit beaches, they may serve as vectors, transporting fecal microorganisms to the beach where they may subsequently contaminate sand and water. In this study, samples collected from landfills, treated wastewater storage lagoons, and public beaches demonstrated a spatial and temporal overlap of markers for gull and human-associated microorganisms. In addition, markers for gull, fecal indicator bacteria, and the human-associated marker, HF183, were detected in gull feces and cloacae samples. Further, HF183 was detected in cloacae samples from gulls that were documented by radio-telemetry traveling between human waste sites and public beaches. This study highlights the potential for gulls that visit human waste sites to disperse human-associated microorganisms in the beach landscape. Copyright © 2017 Elsevier B.V. All rights reserved.

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

EPA Pesticide Factsheets

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

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

ERIC Educational Resources Information Center

Helmer, Matt; Blair, Amy; Gerber, Allison

2012-01-01

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

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.

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.

POTENTIAL FOR GULLS TO TRANSPORT BACTERIA FROM HUMAN WASTE SITES

EPA Science Inventory

This study was designed as a first step in assessing whether gulls visiting human waste sites can acquire human microorganisms and distribute them across the coastal landscape. Beaches, landfills, and a lagoon of treated wastewater located in a coastal Lake Michigan county were t...

Continuing oversight through site monitoring: experiences of an institutional ethics committee in an Indian tertiary-care hospital.

PubMed

Shetty, Yashashri C; Marathe, Padmaja; Kamat, Sandhya; Thatte, Urmila

2012-01-01

WHO-TDR and the Indian Council of Medical Research recommend site visits by institutional ethics committees (IECs) for continued oversight, to ensure the ethical conduct of research. Our IEC conducted seven site visits in 2008-2009 using a standardised format to monitor adherence to protocol and the informed consent process. The study identified issues related to informed consent (6/7), deviation from protocol (5/7), reporting of study progress to the IEC (3/7), recruiting additional participants without IEC approval (2/7), reporting of serious adverse events (1/7), investigator's lack of awareness of protocol and the informed consent document (2/7) and other findings. Investigators were informed about the findings and were asked to submit an explanation. The IEC issued warnings about not repeating such lapses in the future (5/7), restricted enrollment of new participants (2/7), recommended continued good clinical practice training to the study team (4/7), advised the recruitment of additional study coordinators (2/7), and requested the submission of adverse event reports (2/7) or sponsors' audit reports (2/7). Our study showed that the ethical conduct of studies can be ensured by conducting routine site monitoring.

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...

Effects of industrial and investigator disturbance on Arctic-nesting geese

USGS Publications Warehouse

Meixell, Brandt W.; Flint, Paul L.

2017-01-01

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

Learning To Hope: A Study of the Adult Education for the Homeless Program.

ERIC Educational Resources Information Center

Drury, Darrel; Koloski, Judy

A comprehensive study of the Adult Education for the Homeless Program (AEH) was conducted using data from the following sources: program files; focus groups conducted with state project administrators; site visits to 9 local programs in 3 states; surveys of 32 state projects, 230 local programs, 588 service delivery sites, and 2,943 program…

Retention strategies and factors associated with missed visits among low income women at increased risk of HIV acquisition in the US (HPTN 064).

PubMed

Haley, Danielle F; Lucas, Jonathan; Golin, Carol E; Wang, Jing; Hughes, James P; Emel, Lynda; El-Sadr, Wafaa; Frew, Paula M; Justman, Jessica; Adimora, Adaora A; Watson, Christopher Chauncey; Mannheimer, Sharon; Rompalo, Anne; Soto-Torres, Lydia; Tims-Cook, Zandraetta; Carter, Yvonne; Hodder, Sally L

2014-04-01

Women at high-risk for HIV acquisition often face challenges that hinder their retention in HIV prevention trials. These same challenges may contribute to missed clinical care visits among HIV-infected women. This article, informed by the Gelberg-Andersen Behavioral Model for Vulnerable Populations, identifies factors associated with missed study visits and describes the multifaceted retention strategies used by study sites. HPTN 064 was a multisite, longitudinal HIV seroincidence study in 10 US communities. Eligible women were aged 18-44 years, resided in a census tract/zipcode with high poverty and HIV prevalence, and self-reported ≥1 personal or sex partner behavior related to HIV acquisition. Multivariate analyses of predisposing (e.g., substance use) and enabling (e.g., unmet health care needs) characteristics, and study attributes (i.e., recruitment venue, time of enrollment) identified factors associated with missed study visits. Retention strategies included: community engagement; interpersonal relationship building; reduction of external barriers; staff capacity building; and external tracing. Visit completion was 93% and 94% at 6 and 12 months. Unstable housing and later date of enrollment were associated with increased likelihood of missed study visits. Black race, recruitment from an outdoor venue, and financial responsibility for children were associated with greater likelihood of attendance. Multifaceted retention strategies may reduce missed study visits. Knowledge of factors associated with missed visits may help to focus efforts.

Retention Strategies and Factors Associated with Missed Visits Among Low Income Women at Increased Risk of HIV Acquisition in the US (HPTN 064)

PubMed Central

Lucas, Jonathan; Golin, Carol E.; Wang, Jing; Hughes, James P.; Emel, Lynda; El-Sadr, Wafaa; Frew, Paula M.; Justman, Jessica; Adimora, Adaora A.; Watson, Christopher Chauncey; Mannheimer, Sharon; Rompalo, Anne; Soto-Torres, Lydia; Tims-Cook, Zandraetta; Carter, Yvonne; Hodder, Sally L.

2014-01-01

Abstract Women at high-risk for HIV acquisition often face challenges that hinder their retention in HIV prevention trials. These same challenges may contribute to missed clinical care visits among HIV-infected women. This article, informed by the Gelberg-Andersen Behavioral Model for Vulnerable Populations, identifies factors associated with missed study visits and describes the multifaceted retention strategies used by study sites. HPTN 064 was a multisite, longitudinal HIV seroincidence study in 10 US communities. Eligible women were aged 18–44 years, resided in a census tract/zipcode with high poverty and HIV prevalence, and self-reported ≥1 personal or sex partner behavior related to HIV acquisition. Multivariate analyses of predisposing (e.g., substance use) and enabling (e.g., unmet health care needs) characteristics, and study attributes (i.e., recruitment venue, time of enrollment) identified factors associated with missed study visits. Retention strategies included: community engagement; interpersonal relationship building; reduction of external barriers; staff capacity building; and external tracing. Visit completion was 93% and 94% at 6 and 12 months. Unstable housing and later date of enrollment were associated with increased likelihood of missed study visits. Black race, recruitment from an outdoor venue, and financial responsibility for children were associated with greater likelihood of attendance. Multifaceted retention strategies may reduce missed study visits. Knowledge of factors associated with missed visits may help to focus efforts. PMID:24697160

Traveling Exhibitions as Sites for Informal Learning: Assessing Different Strategies with Field Trips to Traveling Exhibitions at Non-Museum Sites

ERIC Educational Resources Information Center

Harker, Richard J. W.; Badger, James

2015-01-01

This study investigated the use of different pedagogical techniques to create an intellectually engaging experience for middle school students who visited a traveling exhibition from the United States Holocaust Memorial Museum at a non-museum host site: the University of North Georgia Dahlonega's Library and Technology Center. The findings of this…

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.

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.

Maintaining High Quality Data and Consistency Across a Diverse Flux Network: The Ameriflux QA/QC Technical Team

NASA Astrophysics Data System (ADS)

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

2014-12-01

The AmeriFlux quality assurance and quality control (QA/QC) technical team conducts short term (<2 weeks) intercomparisons using a portable eddy covariance system (PECS) to maintain high quality data observations and data consistency across the AmeriFlux network (http://ameriflux.lbl.gov/). Site intercomparisons identify discrepancies between the in situ and portable measurements and calculated fluxes. Findings are jointly discussed by the site staff and the QA/QC team to improve in the situ observations. Despite the relatively short duration of an individual site intercomparison, the accumulated record of all site visits (numbering over 100 since 2002) is a unique dataset. The ability to deploy redundant sensors provides a rare opportunity to identify, quantify, and understand uncertainties in eddy covariance and ancillary measurements. We present a few specific case studies from QA/QC site visits to highlight and share new and relevant findings related to eddy covariance instrumentation and operation.

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

PubMed Central

Hornigold, Karen; Lake, Iain; Dolman, Paul

2016-01-01

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

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...

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

NASA Astrophysics Data System (ADS)

Killeen, T. L.

2003-12-01

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

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....

Quality assurance of research protocols conducted in the community: the National Institute on Drug Abuse Clinical Trials Network experience.

PubMed

Rosa, Carmen; Campbell, Aimee; Kleppinger, Cynthia; Sampson, Royce; Tyson, Clare; Mamay-Gentilin, Stephanie

2009-04-01

Quality assurance (QA) of clinical trials is essential to protect the welfare of trial participants and the integrity of the data collected. However, there is little detailed information available on specific procedures and outcomes of QA monitoring for clinical trials. This article describes the experience of the National Institute on Drug Abuse's (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) in devising and implementing a three-tiered QA model for rigorous multi-site randomized clinical trials implemented in community-based substance abuse treatment programs. The CTN QA model combined local and national resources and was developed to address the unique needs of clinical trial sites with limited research experience. The authors reviewed internal records maintained by the sponsor, a coordinating site (Lead Nodes), and a local site detailing procedural development, training sessions, protocol violation monitoring, and site visit reporting. Between January 2001 and September 2005, the CTN implemented 21 protocols, of which 18 were randomized clinical trials, one was a quality improvement study and two were surveys. Approximately 160 community-based treatment programs participated in the 19 studies that were monitored, with a total of 6560 participants randomized across the sites. During this time 1937 QA site visits were reported across the three tiers of monitoring and the cost depended on the location of the sites and the salaries of the staff involved. One study reported 109 protocol violations (M = 15.6). Examples are presented to highlight training, protocol violation monitoring, site visit frequency and intensity and cost considerations. : QA data from the entire network were not easily available for review as much of the data were not electronically accessible. The authors reviewed and discussed a representative sample of internal data from the studies and participating sites. The lessons learned from the CTN's experience include the need for balancing thoroughness with efficiency, monitoring early, assessing research staff abilities in order to judge the need for proactive, focused attention, providing targeted training sessions, and developing flexible tools. The CTN model can work for sponsors overseeing studies at sites with limited research experience that require more frequent, in-depth monitoring. We recommend that sponsors not develop a rigid monitoring approach, but work with the study principal investigators to determine the intensity of monitoring needed depending on trial complexity, the risks of the intervention(s), and the experience of the staff with clinical research. After careful evaluation, sponsors should then determine the best approach to site monitoring and what resources will be needed.

Quality assurance of research protocols conducted in the community: The National Institute on Drug Abuse Clinical Trials Network Experience

PubMed Central

Rosa, Carmen; Campbell, Aimee; Kleppinger, Cynthia; Sampson, Royce; Tyson, Clare; Mamay-Gentilin, Stephanie

2009-01-01

Background: Quality assurance (QA) of clinical trials is essential to protect the welfare of trial participants and the integrity of the data collected. However, there is little detailed information available on specific procedures and outcomes of QA monitoring for clinical trials. Purpose: This article describes the experience of the National Institute on Drug Abuse's (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) in devising and implementing a three-tiered QA model for rigorous multi-site randomized clinical trials implemented in community-based substance abuse treatment programs. The CTN QA model combined local and national resources and was developed to address the unique needs of clinical trial sites with limited research experience. Methods: The authors reviewed internal records maintained by the sponsor, a coordinating site (Lead Nodes), and a local site detailing procedural development, training sessions, protocol violation monitoring, and site visit reporting. Results: Between January 2001 and September 2005, the CTN implemented 21 protocols, of which 18 were randomized clinical trials, one was a quality improvement study and two were surveys. Approximately 160 community-based treatment programs participated in the 19 studies that were monitored, with a total of 6560 participants randomized across the sites. During this time 1937 QA site visits were reported across the three tiers of monitoring and the cost depended on the location of the sites and the salaries of the staff involved. One study reported 109 protocol violations (M = 15.6). Examples are presented to highlight training, protocol violation monitoring, site visit frequency and intensity and cost considerations. Limitations: QA data from the entire network were not easily available for review as much of the data were not electronically accessible. The authors reviewed and discussed a representative sample of internal data from the studies and participating sites. Conclusions: The lessons learned from the CTN's experience include the need for balancing thoroughness with efficiency, monitoring early, assessing research staff abilities in order to judge the need for proactive, focused attention, providing targeted training sessions, and developing flexible tools. The CTN model can work for sponsors overseeing studies at sites with limited research experience that require more frequent, in-depth monitoring. We recommend that sponsors not develop a rigid monitoring approach, but work with the study principal investigators to determine the intensity of monitoring needed depending on trial complexity, the risks of the intervention(s), and the experience of the staff with clinical research. After careful evaluation, sponsors should then determine the best approach to site monitoring and what resources will be needed. PMID:19342468

Spectral study of suggested Apollo sites. [proposals for financial support and the electronic spectra of pyroxenes

NASA Technical Reports Server (NTRS)

Mccord, T. B.

1973-01-01

The spectrophotometry (0.3 to 1.1 microns) of visited and proposed Apollo landing sites is presented along with proposals for financial support of the spectral study. The electronic spectra of pyroxenes is investigated along with an interpretation of telescopic spectral reflectivity curves of the moon. Reprints of published articles related to these studies are included.

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

PubMed

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

2013-09-08

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

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.

Homeless Families with Children: Programmatic Responses of Five Communities. Volume I: Cross-Site Comparisons and Findings.

ERIC Educational Resources Information Center

Macro Systems, Inc., Silver Spring, MD.

An exploratory study was conducted to examine the ways in which existing programs or service delivery systems have adapted to meet the needs of homeless families with children. Key issues and model and innovative approaches were identified prior to study site visits in five cities: (1) Atlanta (Georgia); (2) Baltimore (Maryland); (3) Boston…

42 CFR 90.8 - Conduct of health assessments and health effects studies.

Code of Federal Regulations, 2011 CFR

2011-10-01

... site visit in connection with a health assessment or health effects study. The ATSDR representative may... release for the limited purpose of determining the existence of current or potential health problems. ...

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

PubMed

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

2011-01-01

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

Introducing disability studies to occupational therapy students.

PubMed

Block, Pamela; Ricafrente-Biazon, Melissa; Russo, Ann; Chu, Ke Yun; Sud, Suman; Koerner, Lori; Vittoria, Karen; Landgrover, Alyssa; Olowu, Tosin

2005-01-01

This article is a work of collaborative ethnography about teaching and learning disability studies within the context of an occupational therapy graduate program. In spring 2004,14 occupational therapy students were introduced to disability studies by their cultural anthropologist (nonoccupational therapist) course instructor. During the one-credit course, they were expected to complete readings, watch films, attend guest lectures, and make a site visit. The occupational therapy students were required to write a journal to record personal reactions and new insights gained from these experiences. This article focuses on a thematic analysis of the students' journaled responses to the film "Dance Me to My Song," and a site visit to a local Independent Living Center. Students were expected to analyze these experiences from both disability studies and occupational therapy perspectives. The article addresses philosophical and practical differences between occupational therapy and disability studies and identifies opportunities for collaboration between occupational therapists and independent living specialists.

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-20

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

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

ERIC Educational Resources Information Center

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

2011-01-01

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

White River National Forest Hanging Lake Capacity Study

DOT National Transportation Integrated Search

2016-05-01

Due to overcrowding at Hanging Lake, the Volpe Center performed a capacity study for the White River National Forest. This capacity study examines the visitation and environmental constraints of Hanging Lake parking lot, trail, and site to develop th...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-07

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

Designing Multi-Channel Web Frameworks for Cultural Tourism Applications: The MUSE Case Study.

ERIC Educational Resources Information Center

Garzotto, Franca; Salmon, Tullio; Pigozzi, Massimiliano

A framework for the design of multi-channel (MC) applications in the cultural tourism domain is presented. Several heterogeneous interface devices are supported including location-sensitive mobile units, on-site stationary devices, and personalized CDs that extend the on-site experience beyond the visit time thanks to personal memories gathered…

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

Indicators and standards of quality across space and time, as reflected in a study in Acadian National Park, Maine

Treesearch

Laura E. Anderson; Robert E. Manning; William A. Valliere

2009-01-01

Recreation indicators and standards of quality may be influenced by: 1) the popularity (or overall use level) of a recreation area and 2) the time of day that an individual chooses to visit a popular site. To examine these connections, data were collected via on-site self-administered surveys at several "high"- and "low"-use sites in Acadia National...

Role of depletion on the dynamics of a diffusing forager

NASA Astrophysics Data System (ADS)

Bénichou, O.; Chupeau, M.; Redner, S.

2016-09-01

We study the dynamics of a starving random walk in general spatial dimension d. This model represents an idealized description for the fate of an unaware forager whose motion is not affected by the presence or absence of resources. The forager depletes its environment by consuming resources and dies if it wanders too long without finding food. In the exactly solvable case of one dimension, we explicitly derive the average lifetime of the walk and the distribution for the number of distinct sites visited by the walk at the instant of starvation. We also give a heuristic derivation for the averages of these two quantities. We tackle the complex but ecologically relevant case of two dimensions by an approximation in which the depleted zone is assumed to always be circular and which grows incrementally each time the walk reaches the edge of this zone. Within this framework, we derive a lower bound for the scaling of the average lifetime and number of distinct sites visited at starvation. We also determine the asymptotic distribution of the number of distinct sites visited at starvation. Finally, we solve the case of high spatial dimensions within a mean-field approach.

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.

Traffic signal preemption for emergency vehicles : a cross-cutting study : putting the "first" in "first response"

DOT National Transportation Integrated Search

2006-01-01

This cross-cutting study identifies issues associated with emergency vehicle operations and emergency vehicle preemption. This study reports information gathered during a review of publications and site visits to three jurisdictions operating emergen...

Analysis of 4999 online physician ratings indicates that most patients give physicians a favorable rating.

PubMed

Kadry, Bassam; Chu, Larry F; Kadry, Bayan; Gammas, Danya; Macario, Alex

2011-11-16

Many online physician-rating sites provide patients with information about physicians and allow patients to rate physicians. Understanding what information is available is important given that patients may use this information to choose a physician. The goals of this study were to (1) determine the most frequently visited physician-rating websites with user-generated content, (2) evaluate the available information on these websites, and (3) analyze 4999 individual online ratings of physicians. On October 1, 2010, using Google Trends we identified the 10 most frequently visited online physician-rating sites with user-generated content. We then studied each site to evaluate the available information (eg, board certification, years in practice), the types of rating scales (eg, 1-5, 1-4, 1-100), and dimensions of care (eg, recommend to a friend, waiting room time) used to rate physicians. We analyzed data from 4999 selected physician ratings without identifiers to assess how physicians are rated online. The 10 most commonly visited websites with user-generated content were HealthGrades.com, Vitals.com, Yelp.com, YP.com, RevolutionHealth.com, RateMD.com, Angieslist.com, Checkbook.org, Kudzu.com, and ZocDoc.com. A total of 35 different dimensions of care were rated by patients in the websites, with a median of 4.5 (mean 4.9, SD 2.8, range 1-9) questions per site. Depending on the scale used for each physician-rating website, the average rating was 77 out of 100 for sites using a 100-point scale (SD 11, median 76, range 33-100), 3.84 out of 5 (77%) for sites using a 5-point scale (SD 0.98, median 4, range 1-5), and 3.1 out of 4 (78%) for sites using a 4-point scale (SD 0.72, median 3, range 1-4). The percentage of reviews rated ≥75 on a 100-point scale was 61.5% (246/400), ≥4 on a 5-point scale was 57.74% (2078/3599), and ≥3 on a 4-point scale was 74.0% (740/1000). The patient's single overall rating of the physician correlated with the other dimensions of care that were rated by patients for the same physician (Pearson correlation, r = .73, P < .001). Most patients give physicians a favorable rating on online physician-rating sites. A single overall rating to evaluate physicians may be sufficient to assess a patient's opinion of the physician. The optimal content and rating method that is useful to patients when visiting online physician-rating sites deserves further study. Conducting a qualitative analysis to compare the quantitative ratings would help validate the rating instruments used to evaluate physicians.

Analysis of 4999 Online Physician Ratings Indicates That Most Patients Give Physicians a Favorable Rating

PubMed Central

Chu, Larry F; Kadry, Bayan; Gammas, Danya; Macario, Alex

2011-01-01

Background Many online physician-rating sites provide patients with information about physicians and allow patients to rate physicians. Understanding what information is available is important given that patients may use this information to choose a physician. Objectives The goals of this study were to (1) determine the most frequently visited physician-rating websites with user-generated content, (2) evaluate the available information on these websites, and (3) analyze 4999 individual online ratings of physicians. Methods On October 1, 2010, using Google Trends we identified the 10 most frequently visited online physician-rating sites with user-generated content. We then studied each site to evaluate the available information (eg, board certification, years in practice), the types of rating scales (eg, 1–5, 1–4, 1–100), and dimensions of care (eg, recommend to a friend, waiting room time) used to rate physicians. We analyzed data from 4999 selected physician ratings without identifiers to assess how physicians are rated online. Results The 10 most commonly visited websites with user-generated content were HealthGrades.com, Vitals.com, Yelp.com, YP.com, RevolutionHealth.com, RateMD.com, Angieslist.com, Checkbook.org, Kudzu.com, and ZocDoc.com. A total of 35 different dimensions of care were rated by patients in the websites, with a median of 4.5 (mean 4.9, SD 2.8, range 1–9) questions per site. Depending on the scale used for each physician-rating website, the average rating was 77 out of 100 for sites using a 100-point scale (SD 11, median 76, range 33–100), 3.84 out of 5 (77%) for sites using a 5-point scale (SD 0.98, median 4, range 1–5), and 3.1 out of 4 (78%) for sites using a 4-point scale (SD 0.72, median 3, range 1–4). The percentage of reviews rated ≥75 on a 100-point scale was 61.5% (246/400), ≥4 on a 5-point scale was 57.74% (2078/3599), and ≥3 on a 4-point scale was 74.0% (740/1000). The patient’s single overall rating of the physician correlated with the other dimensions of care that were rated by patients for the same physician (Pearson correlation, r = .73, P < .001). Conclusions Most patients give physicians a favorable rating on online physician-rating sites. A single overall rating to evaluate physicians may be sufficient to assess a patient’s opinion of the physician. The optimal content and rating method that is useful to patients when visiting online physician-rating sites deserves further study. Conducting a qualitative analysis to compare the quantitative ratings would help validate the rating instruments used to evaluate physicians. PMID:22088924

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.…

'heartfailurematters.org', an educational website for patients and carers from the Heart Failure Association of the European Society of Cardiology: objectives, use and future directions.

PubMed

Wagenaar, Kim P; Rutten, Frans H; Klompstra, Leonie; Bhana, Yusuf; Sieverink, Floor; Ruschitzka, Frank; Seferovic, Petar M; Lainscak, Mitja; Piepoli, Massimo F; Broekhuizen, Berna D L; Strömberg, Anna; Jaarsma, Tiny; Hoes, Arno W; Dickstein, Kenneth

2017-11-01

In 2007, the Heart Failure Association of the European Society of Cardiology (ESC) launched the information website heartfailurematters.org (HFM site) with the aim of creating a practical tool through which to provide advice and guidelines for living with heart failure to patients, their carers, health care professionals and the general public worldwide. The website is managed by the ESC at the European Heart House and is currently available in nine languages. The aim of this study is to describe the background, objectives, use, lessons learned and future directions of the HFM site. Data on the number of visitor sessions on the site as measured by Google Analytics were used to explore use of the HFM site from 2010 to 2015. Worldwide, the annual number of sessions increased from 416 345 in 2010 to 1 636 368 in 2015. Most users (72-75%) found the site by using a search engine. Desktops and, more recently, smartphones were used to visit the website, accounting for 50% and 38%, respectively, of visits to the site in 2015. Although its use has increased, the HFM site has not yet reached its full potential: fewer than 2 million users have visited the website, whereas the number of people living with heart failure worldwide is estimated to be 23 million. Uptake and use could be further improved by a continuous process of qualitative assessment of users' preferences, and the provision of professional helpdesk facilities, comprehensive information technology, and promotional support. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

Identifying diabetes knowledge network nodes as sites for a diabetes prevention program.

PubMed

Gesler, Wilbert M; Arcury, Thomas A; Skelly, Anne H; Nash, Sally; Soward, April; Dougherty, Molly

2006-12-01

This paper reports on the methods used and results of a study that identified specific places within a community that have the potential to be sites for a diabetes prevention program. These sites, termed diabetes knowledge network nodes (DKNNs), are based on the concept of socio-spatial knowledge networks (SSKNs), the web of social relationships within which people obtain knowledge about type 2 diabetes. The target population for the study was working poor African Americans, Latinos, and European Americans of both sexes in a small rural southern town who had not been diagnosed with diabetes. Information was collected from a sample of 121 respondents on the places they visited in carrying out their daily activities. Data on number of visits to specific sites, degree of familiarity with these sites, and ratings of sites as places to receive diabetes information were used to develop three categories of DKNNs for six subgroups based on ethnicity and sex. Primary potential sites of importance to one or more subgroups included churches, grocery stores, drugstores, the local library, a beauty salon, laundromats, a community service agency, and a branch of the County Health Department. Secondary potential sites included gas stations, restaurants, banks, and post offices. Latent potential sites included three medical facilities. Most of the DKNNs were located either in the downtown area or in one of two shopping areas along the most used highway that passed through the town. The procedures used in this study can be generalized to other communities and prevention programs for other chronic diseases.

International use of an academic nephrology World Wide Web site: from medical information resource to business tool.

PubMed

Abbott, Kevin C; Oliver, David K; Boal, Thomas R; Gadiyak, Grigorii; Boocks, Carl; Yuan, Christina M; Welch, Paul G; Poropatich, Ronald K

2002-04-01

Studies of the use of the World Wide Web to obtain medical knowledge have largely focused on patients. In particular, neither the international use of academic nephrology World Wide Web sites (websites) as primary information sources nor the use of search engines (and search strategies) to obtain medical information have been described. Visits ("hits") to the Walter Reed Army Medical Center (WRAMC) Nephrology Service website from April 30, 2000, to March 14, 2001, were analyzed for the location of originating source using Webtrends, and search engines (Google, Lycos, etc.) were analyzed manually for search strategies used. From April 30, 2000 to March 14, 2001, the WRAMC Nephrology Service website received 1,007,103 hits and 12,175 visits. These visits were from 33 different countries, and the most frequent regions were Western Europe, Asia, Australia, the Middle East, Pacific Islands, and South America. The most frequent organization using the site was the military Internet system, followed by America Online and automated search programs of online search engines, most commonly Google. The online lecture series was the most frequently visited section of the website. Search strategies used in search engines were extremely technical. The use of "robots" by standard Internet search engines to locate websites, which may be blocked by mandatory registration, has allowed users worldwide to access the WRAMC Nephrology Service website to answer very technical questions. This suggests that it is being used as an alternative to other primary sources of medical information and that the use of mandatory registration may hinder users from finding valuable sites. With current Internet technology, even a single service can become a worldwide information resource without sacrificing its primary customers.

Internet Uses and Gratifications: Understanding Motivations for Using the Internet.

ERIC Educational Resources Information Center

Ko, Hanjun

In this study, the uses and gratifications theory was applied to investigate the Internet users' motivations and their relationship with attitudes toward the Internet as well as types of Web site visited by users. Subjects were 185 college students who completed a self-report questionnaire. Four motivations and five types of Web sites were…

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

ERIC Educational Resources Information Center

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

2006-01-01

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

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

PubMed

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

2010-08-01

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

Prevention for College Students Who Suffer Alcohol-Induced Blackouts Could Deter High-Cost Emergency Department Visits

PubMed Central

Mundt, Marlon P.; Zakletskaia, Larissa I.

2012-01-01

Fifty percent of college students who drink report alcohol-induced blackouts, and alcohol abusers in general put a heavy burden on the medical care system. Using data drawn from a randomized, controlled alcohol intervention trial at five university sites, our study quantified the costs of visits to emergency departments by college students who experienced blackouts from drinking alcohol. Of 954 students in the study, 52 percent of males and 50 percent of females at the outset of the study had experienced an alcohol-induced blackout in the past year. Of 404 emergency department visits among the study participants over a two-year observation period, about one in eight were associated with blackout drinking. Injuries ranged from broken bones to head and brain injuries requiring computed tomography. We calculate that on a large university campus having more than 40,000 students, blackout-associated emergency department visit costs would range from $469,000 to $546,000 per year. We conclude that blackouts are a strong predictor of emergency department visits for college drinkers and that prevention efforts aimed at students with a history of blackouts might reduce injuries and emergency department costs. PMID:22422503

An ounce of prevention: A pre-randomization protocol to improve retention in substance use disorder clinical trials.

PubMed

Northrup, Thomas F; Greer, Tracy L; Walker, Robrina; Rethorst, Chad D; Warden, Diane; Stotts, Angela L; Trivedi, Madhukar H

2017-01-01

Missing data in substance use disorder (SUD) research pose a significant threat to internal validity. Participants terminate involvement or become less likely to attend intervention and research visits for many reasons, which should be addressed prior to becoming problematic. During a 9-month study targeting stimulant abuse, early dropouts and participant reported attendance barriers led to implementing a structured, pre-randomization protocol with participants about retention and solution-focused strategies (the "Fireside Chat"). Our aim is to outline this approach and present data on intervention participation and research visit attendance after implementation. STimulant Reduction using Dosed Exercise (STRIDE) was a two-arm, multisite randomized clinical trial testing treatment-as-usual for stimulant abuse/dependence augmented by Exercise or Health Education. For both groups, study intervention visits at the site were scheduled 3/week for 12weeks followed by 1/week for 24weeks. During The Chat, research staff thoroughly reviewed participants' expectations, and barriers and solutions to retention. Fifteen participants were randomized (to Exercise or Health Education) prior to and fourteen were randomized after Chat implementation. Intervention and monthly follow-up attendance (before and after implementation) were compared at the site (N=29) that developed and rigorously implemented The Chat. Individuals who participated in The Chat (n=14) attended significantly more intervention visits during weeks 1-12 (p<0.001) and weeks 13-36 (p<0.05) and attended more research visits (p<0.001). Proactive discussion of expectations and barriers prior to randomization was associated with greater study attendance. SUD researchers should consider tailoring this approach to suit their needs. Further investigation is warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed

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

2017-01-01

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

Implementation of Evidence-Based Employment Services in Specialty Mental Health

PubMed Central

Hamilton, Alison B; Cohen, Amy N; Glover, Dawn L; Whelan, Fiona; Chemerinski, Eran; McNagny, Kirk P; Mullins, Deborah; Reist, Christopher; Schubert, Max; Young, Alexander S

2013-01-01

Objective. Study a quality improvement approach for implementing evidence-based employment services at specialty mental health clinics. Data Sources/Study Setting. Semistructured interviews with clinicians and administrators before, during, and after implementation. Qualitative field notes, structured baseline and follow-up interviews with patients, semistructured interviews with patients after implementation, and administrative data. Study Design. Site-level controlled trial at four implementation and four control sites. Hybrid implementation–effectiveness study with mixed methods intervention evaluation design. Data Collection/Extraction Methods. Site visits, in-person and telephone interviews, patient surveys, patient self-assessment. A total of 801 patients completed baseline surveys and 53 clinicians and other clinical key stakeholders completed longitudinal qualitative interviews. Principal Findings. At baseline, sites varied in the availability, utilization, and quality of supported employment. Each site needed quality improvement for this service, though for differing reasons, with some needing development of the service itself and others needing increased service capacity. Improvements in knowledge, attitudes, beliefs, and referral behaviors were evident in mid- and postimplementation interviews, though some barriers persisted. Half of patients expressed an interest in working at baseline. Patients at implementation sites were 2.3 times more likely to receive employment services during the study year. Those who had a service visit were more likely to be employed at follow-up than those who did not. Conclusions. Studies of implementation and effectiveness require mixed methods to both enhance implementation in real time and provide context for interpretation of complex results. In this study, a quality improvement approach resulted in superior patient-level outcomes and improved clinician knowledge, attitudes, and behaviors, in the context of substantial variation among sites. PMID:24138608

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...

Atlanta Wheelchair Accessible Bus Study

DOT National Transportation Integrated Search

1978-08-01

This document describes the implementation and operation of the Metropolitan Atlanta Rapid Transit Authority's fixed-route, subscription service for handicapped individuals. It is based on a site visit and discussions with several individuals in the ...

40 CFR 1.27 - Offices of the Associate Administrators.

Code of Federal Regulations, 2013 CFR

2013-07-01

... establishes Agency policy, and approves annual plans and modifications for travel abroad and attendance at.... The Office initiates and conducts on-site field visits to study, analyze, and resolve problems of...

40 CFR 1.27 - Offices of the Associate Administrators.

Code of Federal Regulations, 2014 CFR

2014-07-01

... establishes Agency policy, and approves annual plans and modifications for travel abroad and attendance at.... The Office initiates and conducts on-site field visits to study, analyze, and resolve problems of...

40 CFR 1.27 - Offices of the Associate Administrators.

Code of Federal Regulations, 2011 CFR

2011-07-01

... establishes Agency policy, and approves annual plans and modifications for travel abroad and attendance at.... The Office initiates and conducts on-site field visits to study, analyze, and resolve problems of...

40 CFR 1.27 - Offices of the Associate Administrators.

Code of Federal Regulations, 2010 CFR

2010-07-01

... establishes Agency policy, and approves annual plans and modifications for travel abroad and attendance at.... The Office initiates and conducts on-site field visits to study, analyze, and resolve problems of...

Study of biological communities subject to imperfect detection: Bias and precision of community N-mixture abundance models in small-sample situations

USGS Publications Warehouse

Yamaura, Yuichi; Kery, Marc; Royle, Andy

2016-01-01

Community N-mixture abundance models for replicated counts provide a powerful and novel framework for drawing inferences related to species abundance within communities subject to imperfect detection. To assess the performance of these models, and to compare them to related community occupancy models in situations with marginal information, we used simulation to examine the effects of mean abundance (λ¯: 0.1, 0.5, 1, 5), detection probability (p¯: 0.1, 0.2, 0.5), and number of sampling sites (n site : 10, 20, 40) and visits (n visit : 2, 3, 4) on the bias and precision of species-level parameters (mean abundance and covariate effect) and a community-level parameter (species richness). Bias and imprecision of estimates decreased when any of the four variables (λ¯, p¯, n site , n visit ) increased. Detection probability p¯ was most important for the estimates of mean abundance, while λ¯ was most influential for covariate effect and species richness estimates. For all parameters, increasing n site was more beneficial than increasing n visit . Minimal conditions for obtaining adequate performance of community abundance models were n site  ≥ 20, p¯ ≥ 0.2, and λ¯ ≥ 0.5. At lower abundance, the performance of community abundance and community occupancy models as species richness estimators were comparable. We then used additive partitioning analysis to reveal that raw species counts can overestimate β diversity both of species richness and the Shannon index, while community abundance models yielded better estimates. Community N-mixture abundance models thus have great potential for use with community ecology or conservation applications provided that replicated counts are available.

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

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

Visiting Entertainment Venues and Sexual Health in China

PubMed Central

Li, Li; Wu, Zunyou; Rotheram-Borus, Mary Jane; Guan, Jihui; Yin, Yueping; Detels, Roger; Wu, Sheng; Lee, Sung-Jae; Cao, Haijun; Lin, Chunqing; Rou, Keming; Liu, Zhendong

2010-01-01

Entertainment venues in China are associated with risky sexual behavior. Most previous studies related to entertainment venues in China have focused on sex workers and commercial sex, but this study addressed sexual health in a sample of the general urban population. A randomly selected sample of market vendors (n = 4,510) from an eastern city was recruited and assessed to examine relationships between entertainment venue visits and sexual risk. Both behavioral (self-reports of unprotected sex) and biomedical (STD test results) measures were used. About 18% of the sample (26.8% of men and 9% of women) reported visiting entertainment venues in the past 30 days. Those who visited entertainment venues were more likely to be male, younger, single, with higher education, and to have more discretionary income. For both men and women, visiting entertainment venues was a significant predictor for unprotected sex and STD infection. Gender differences were observed in predicting unprotected sex and STD infections. Entertainment venues could be potential sites for place-based intervention programs and out-reach for the general population. PMID:18256918

Trams, trains, planes and automobiles: logistics of conducting a statewide audit of medical records.

PubMed

Flood, Margaret; Pollock, Wendy; McDonald, Susan; Davey, Mary-Ann

2016-10-01

This paper reports on the logistics of conducting a validation study of a routinely collected dataset against medical records at hospitals to inform planning of similar studies. A stratified random sample of 15 hospitals and two homebirth practitioners was included. Site visits were arranged following consent. In addition to the validation of perinatal data, information was collected regarding logistics. Records at 14 metropolitan and rural hospitals up to 500 km from the research centre, and two homebirth practitioners, were audited. Obtaining consent to participate took between 5 days and 10 months. Auditors visited sites on 101 days, auditing 737 medical record pairs at 16 sites. Median audit time per record was 51.3 minutes; electronic records each took 36 minutes longer than paper. Travel time accounted for nearly one-quarter of audit time. Delays obtaining consents, long travel times and electronic records prolonged audit duration and expense. Employment of experts maximised use of available audit time. Conducting a validation study is a time-consuming and expensive exercise; however, confidence in the accuracy of public health data is vital. Validation studies are unquestionably important. Three alternative strategies have been proposed to make future studies viable. © 2016 Public Health Association of Australia.

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

PubMed Central

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

2017-01-01

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

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

75 FR 74024 - Notice of Submission for OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-30

... purpose of the Study of School Turnaround is to document over time the intervention models, approaches... with school principals, district administrators and state officials; site visits to case study schools... study team will conduct in-depth case studies over three years, and two sets of 10 ``special topics...

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

Highlights of NASA/DOE photovoltaics market assessment visit to Colombia

NASA Technical Reports Server (NTRS)

1981-01-01

A NASA/DOE sponsored photovoltaic market assessment team composed of representatives of NASA-Lewis Research Center, DHR, Inc., and Associates in Rural Development, Inc. recently conducted a month-long study in Colombia (June 28 - July 23). The team contacted government officials and private sector representatives in Bogota and Cali, and visited rural development and agricultural sites in the departments of Cundinamarca, Caldas, Valle, and chada to determine the potential market for American photovoltaic products in the Colombia agricultural and rural sectors.

Invasion of a dominant floral resource: effects on the floral community and pollination of native plants.

PubMed

Goodell, Karen; Parker, Ingrid M

2017-01-01

Through competition for pollinators, invasive plants may suppress native flora. Community-level studies provide an integrative assessment of invasion impacts and insights into factors that influence the vulnerability of different native species. We investigated effects of the nonnative herb Lythrum salicaria on pollination of native species in 14 fens of the eastern United States. We compared visitors per flower for 122 native plant species in invaded and uninvaded fens and incorporated a landscape-scale experiment, removing L. salicaria flowers from three of the invaded fens. Total flower densities were more than three times higher in invaded than uninvaded or removal sites when L. salicaria was blooming. Despite an increase in number of visitors with number of flowers per area, visitors per native flower declined with increasing numbers of flowers. Therefore, L. salicaria invasion depressed visitation to native flowers. In removal sites, visitation to native flowers was similar to uninvaded sites, confirming the observational results and also suggesting that invasion had not generated a persistent build-up of visitor populations. To study species-level impacts, we examined effects of invasion on visitors per flower for the 36 plant species flowering in both invaded and uninvaded fens. On average, the effect of invasion represented about a 20% reduction in visits per flower. We measured the influence of plant traits on vulnerability to L. salicaria invasion using meta-analysis. Bilaterally symmetrical flowers experienced stronger impacts on visitation, and similarity in flower color to L. salicaria weakly intensified competition with the invader for visitors. Finally, we assessed the reproductive consequences of competition with the invader in a dominant flowering shrub, Dasiphora fruticosa. Despite the negative effect of invasion on pollinator visitation in this species, pollen limitation of seed production was not stronger in invaded than in uninvaded sites, suggesting little impact of competition for pollinators on its population demography. Negative effects on pollination of native plants by this copiously flowering invader appeared to be mediated by increases in total flower density that were not matched by increases in pollinator density. The strength of impact was modulated across native species by their floral traits and reproductive ecology. © 2016 The Authors. Ecology, published by Wiley Periodicals, Inc., on behalf of the Ecological Society of America.

Toxic anterior segment syndrome: Update on the most common causes.

PubMed

Bodnar, Zachary; Clouser, Sue; Mamalis, Nick

2012-11-01

To determine how the most common risk factors for toxic anterior segment syndrome (TASS) have evolved over the past decade. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Cross-sectional study. This was a retrospective analysis of surveys from centers reporting cases of TASS from June 1, 2007, through March 1, 2012, and information from visits to afflicted sites between October 1, 2005, and December 31, 2011. Results from June 1, 2009, to March 1, 2012, were compared with those collected before June 1, 2009. The data from 130 questionnaires and 71 site visits were analyzed. The reporting centers performed approximately 69 000 surgeries and reported 1454 cases of TASS. Several trends were noted when comparing the most recent data with previously reported results. There was a 26% reduction in sites reporting inadequate handpiece flushing volumes and a 27% increase in sites using a deionized/distilled final rinse. At sites visited, there was a 36% reduction in the use of preserved epinephrine and a 36% reduction in the use of enzymatic detergents. However, there was a 21% increase in handling of intraocular lenses or instrument tips with gloved hands, a 47% increase in poor instrument maintenance, and a 34% increase in ultrasound bath use without adequate routine cleaning. Education may have improved some instrument-cleaning and perioperative practices that increase the risk for TASS; however, other practices may be headed in an unfavorable direction. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Floral Visitors of Three Asteraceae Species in a Xeric Environment in Central Mexico.

PubMed

Figueroa-Castro, Dulce María; González-Tochihuitl, Guadalupe; Rivas-Arancibia, Sombra Patricia; Castaño-Meneses, Gabriela

2016-12-01

We describe the spatial variation in the structure and composition of the communities of insects visiting the inflorescences of Flaveria ramosissima Klatt, Florestina pedata (Cav.) Cass., and Parthenium bipinnatifidum (Ort.) Rollins (Asteraceae) in a xeric environment in Central Mexico. Inflorescences of the three Asteraceae were visited by a total of 96 species of Hymenoptera, Diptera, Lepidoptera, Coleoptera, and Hemiptera. Total species richness of floral visitors to the three Asteraceae and total abundance of insects of Fl. pedata and P. bipinnatifidum did not differ between low and high vegetation cover sites. Total abundance of insects visiting the inflorescences of F. ramosissima and abundance of Hymenoptera in all three Asteraceae were higher at the low vegetation coverage (LVC) site than at the high vegetation coverage (HVC) one. Diversity of insects of Fl. pedata and P. bipinnatifidum was higher at the HVC site. However, in F. ramosissima diversity was higher at the LVC site. The communities of insects of each Asteraceae were dissimilar between sites. These differences can be attributed to variation in the abundance of Lepidophora (Diptera: Bombyliidae), Miridae (Hemiptera), Melyridae (Coleoptera), Tiphiidae (Hymenoptera), Myrmecocystus mexicanus Wesmael, and Dorymyrmex grandulus (Forel) (Hymenoptera: Formicidae). The first three insect groups were sensitive to LVC, high temperature, and low humidity, whereas the last three tolerated those same environmental conditions. Changes in temperature, humidity, and resources associated with vegetation coverage seem to differentially affect each species of floral visitors of the three Asteraceae species studied. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Manú Gradient as a study system for bird pollination.

PubMed

Boehm, Mannfred Ma; Scholer, Micah N; Kennedy, Jeremiah Jc; Heavyside, Julian M; Daza, Aniceto; Guevara-Apaza, David; Jankowski, Jill E

2018-01-01

This study establishes an altiudinal gradient, spanning from the highland Andes (2400 m) to lowland Amazon, as a productive region for the study of bird pollination in Southeastern Peru. The 'Manú Gradient' has a rich history of ornithological research, the published data and resources from which lay the groundwork for analyses of plant-bird interactions. In this preliminary expedition we documented 44 plants exhibting aspects of the bird pollination syndrome, and made field observations of hummingbird visits at three sites spanning the Manú Gradient: 2800 m (Wayqecha), 1400 m (San Pedro), and 400 m (Pantiacolla). Some of the documented plant taxa are underrepresented in the bird pollination literature and could be promising avenues for future analyses of their pollination biology. The Manú Gradient is currently the focus of a concerted, international effort to describe and study the birds in the region; we propose that this region of Southeastern Peru is a productive and perhaps underestimated system to gain insight into the ecology and evolution of bird pollination. Observations were made on 11, 19, and 14 putatively bird pollinated plant species found at the high-, mid- and low-elevation sites along the gradient, respectively. Hummingbirds visited 18 of these plant species, with some plant species being visited by multiple hummingbird species or the same hummingbird species on differing occasions. Morphometric data is presented for putatively bird-pollinated plants, along with bill measurements from hummingbirds captured at each of three sites. Voucher specimens from this study are deposited in the herbaria of the Universidad Nacional de Agraria de La Molina (MOL), Peru and the University of British Columbia (UBC), Canada. The specimens collected represent a 'snapshot' of the diversity of bird-pollinated flora as observed over 10 day sampling windows (per site) during the breeding season for hummingbirds of Manú .

Mineral licks: motivational factors for visitation and accompanying disease risk at communal use sites of elk and deer.

PubMed

Lavelle, Michael J; Phillips, Gregory E; Fischer, Justin W; Burke, Patrick W; Seward, Nathan W; Stahl, Randal S; Nichols, Tracy A; Wunder, Bruce A; VerCauteren, Kurt C

2014-12-01

Free-ranging cervids acquire most of their essential minerals through forage consumption, though occasionally seek other sources to account for seasonal mineral deficiencies. Mineral sources occur as natural geological deposits (i.e., licks) or as anthropogenic mineral supplements. In both scenarios, these sources commonly serve as focal sites for visitation. We monitored 11 licks in Rocky Mountain National Park, north-central Colorado, using trail cameras to quantify daily visitation indices (DVI) and soil consumption indices (SCI) for Rocky Mountain elk (Cervus elaphus) and mule deer (Odocoileus hemionus) during summer 2006 and documented elk, mule deer, and moose (Alces alces) visiting licks. Additionally, soil samples were collected, and mineral concentrations were compared to discern levels that explain rates of visitation. Relationships between response variables; DVI and SCI, and explanatory variables; elevation class, moisture class, period of study, and concentrations of minerals were examined. We found that DVI and SCI were greatest at two wet, low-elevation licks exhibiting relatively high concentrations of manganese and sodium. Because cervids are known to seek Na from soils, we suggest our observed association of Mn with DVI and SCI was a likely consequence of deer and elk seeking supplemental dietary Na. Additionally, highly utilized licks such as these provide an area of concentrated cervid occupation and interaction, thus increasing risk for environmental transmission of infectious pathogens such as chronic wasting disease, which has been shown to be shed in the saliva, urine, and feces of infected cervids.

Two invasive acacia species secure generalist pollinators in invaded communities

NASA Astrophysics Data System (ADS)

Montesinos, Daniel; Castro, Sílvia; Rodríguez-Echeverría, Susana

2016-07-01

Exotic entomophilous plants need to establish effective pollinator interactions in order to succeed after being introduced into a new community, particularly if they are obligatory outbreeders. By establishing these novel interactions in the new non-native range, invasive plants are hypothesised to drive changes in the composition and functioning of the native pollinator community, with potential impacts on the pollination biology of native co-flowering plants. We used two different sites in Portugal, each invaded by a different acacia species, to assess whether two native Australian trees, Acacia dealbata and Acacia longifolia, were able to recruit pollinators in Portugal, and whether the pollinator community visiting acacia trees differed from the pollinator communities interacting with native co-flowering plants. Our results indicate that in the invaded range of Portugal both acacia species were able to establish novel mutualistic interactions, predominantly with generalist pollinators. For each of the two studied sites, only two other co-occurring native plant species presented partially overlapping phenologies. We observed significant differences in pollinator richness and visitation rates among native and non-native plant species, although the study of β diversity indicated that only the native plant Lithodora fruticosa presented a differentiated set of pollinator species. Acacias experienced a large number of visits by numerous pollinator species, but massive acacia flowering resulted in flower visitation rates frequently lower than those of the native co-flowering species. We conclude that the establishment of mutualisms in Portugal likely contributes to the effective and profuse production of acacia seeds in Portugal. Despite the massive flowering of A. dealbata and A. longifolia, native plant species attained similar or higher visitation rates than acacias.

Visiting Holocaust-Related Sites with Medical Students as an Aid in Teaching Medical Ethics.

PubMed

González-López, Esteban; Ríos-Cortés, Rosa

2016-05-01

During the Nazi period numerous doctors and nurses played a nefarious role. In Germany they were responsible for the sterilization and killing of disabled persons. Furthermore, the Nazi doctors used concentration camp inmates as guinea pigs in medical experiments for military or racial purposes. A study of the collaboration of doctors with National Socialism exemplifies behavior that must be avoided. Combining medical teaching with lessons from the Holocaust could be a way to transmit Medical Ethics to doctors, nurses and students. The authors describe a study tour with medical students to Poland, to the largest Nazi extermination camp, Auschwitz, and to the city of Krakow. The tour is the final component of a formal course entitled: "The Holocaust, a Reflection from Medicine" at the Autónoma University of Madrid, Spain. Visiting sites related to the Holocaust, the killing centers and the sites where medical experiments were conducted has a singular meaning for medical students. Tolerance, non-discrimination, and the value of human life can be both learnt and taught at the very place where such values were utterly absent.

Assessing bat detectability and occupancy with multiple automated echolocation detectors

USGS Publications Warehouse

Gorresen, P.M.; Miles, A.C.; Todd, C.M.; Bonaccorso, F.J.; Weller, T.J.

2008-01-01

Occupancy analysis and its ability to account for differential detection probabilities is important for studies in which detecting echolocation calls is used as a measure of bat occurrence and activity. We examined the feasibility of remotely acquiring bat encounter histories to estimate detection probability and occupancy. We used echolocation detectors coupled to digital recorders operating at a series of proximate sites on consecutive nights in 2 trial surveys for the Hawaiian hoary bat (Lasiurus cinereus semotus). Our results confirmed that the technique is readily amenable for use in occupancy analysis. We also conducted a simulation exercise to assess the effects of sampling effort on parameter estimation. The results indicated that the precision and bias of parameter estimation were often more influenced by the number of sites sampled than number of visits. Acceptable accuracy often was not attained until at least 15 sites or 15 visits were used to estimate detection probability and occupancy. The method has significant potential for use in monitoring trends in bat activity and in comparative studies of habitat use. ?? 2008 American Society of Mammalogists.

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

Visitors and Resident Autonomy: Spoken and Unspoken Rules in Assisted Living.

PubMed

Bennett, Colleen R; Frankowski, Ann Christine; Rubinstein, Robert L; Peeples, Amanda D; Perez, Rosa; Nemec, Mary; Tucker, Gretchen G

2017-04-01

This article explores resident autonomy in assisted living (AL) and the effects that visitors and visiting the AL have on that autonomy. We examine formal and informal policies that govern visiting in AL, stakeholders' views and enforcement of these policies, and the complex arrangements that visiting often entails in everyday life in the setting. Data are drawn from a multiyear ethnographic study of autonomy in AL. Research from multiple sites included participant observation, informal and in-depth, open-ended interviews of various stakeholders, and the writing of field notes. Research team biweekly discussions and the Atlas.ti software program facilitated coding and analysis of interview transcripts and fieldnotes. Our ethnographic data highlight complicated factors related to visitors and visiting in AL. We discuss two important aspects of visiting: (a) formal and informal policies at each setting; and (b) how resident autonomy is expressed or suppressed through rules about visiting in AL. Our data underscore the importance of resident autonomy and quality of care in relation to visitors and visiting, especially how this relationship is affected by inconsistent and confusing formal and informal visiting policies in AL. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessment of national dosimetry quality audits results for teletherapy machines from 1989 to 2015.

PubMed

Muhammad, Wazir; Ullah, Asad; Mahmood, Khalid; Matiullah

2016-01-01

The purpose of this study was to ensure accuracy in radiation dose delivery, external dosimetry quality audit has an equal importance with routine dosimetry performed at clinics. To do so, dosimetry quality audit was organized by the Secondary Standard Dosimetry Laboratory (SSDL) of Pakistan Institute of Nuclear Science and Technology (PINSTECH) at the national level to investigate and minimize uncertainties involved in the measurement of absorbed dose, and to improve the accuracy of dose measurement at different radiotherapy hospitals. A total of 181 dosimetry quality audits (i.e., 102 of Co-60 and 79 of linear accelerators) for teletherapy units installed at 22 different sites were performed from 1989 to 2015. The percent deviation between users’ calculated/stated dose and evaluated dose (in the result of on-site dosimetry visits) were calculated and the results were analyzed with respect to the limits of ± 2.5% (ICRU "optimal model") ± 3.0% (IAEA on-site dosimetry visits limit) and ± 5.0% (ICRU minimal or "lowest acceptable" model). The results showed that out of 181 total on-site dosimetry visits, 20.44%, 16.02%, and 4.42% were out of acceptable limits of ± 2.5% ± 3.0%, and ± 5.0%, respectively. The importance of a proper ongoing quality assurance program, recommendations of the followed protocols, and properly calibrated thermometers, pressure gauges, and humidity meters at radiotherapy hospitals are essential in maintaining consistency and uniformity of absorbed dose measurements for precision in dose delivery.

Detecting grizzly bear use of ungulate carcasses using global positioning system telemetry and activity data

USGS Publications Warehouse

Ebinger, Michael R.; Haroldson, Mark A.; van Manen, Frank T.; Costello, Cecily M.; Bjornlie, Daniel D.; Thompson, Daniel J.; Gunther, Kerry A.; Fortin, Jennifer K.; Teisberg, Justin E.; Pils, Shannon R; White, P J; Cain, Steven L.; Cross, Paul C.

2016-01-01

Global positioning system (GPS) wildlife collars have revolutionized wildlife research. Studies of predation by free-ranging carnivores have particularly benefited from the application of location clustering algorithms to determine when and where predation events occur. These studies have changed our understanding of large carnivore behavior, but the gains have concentrated on obligate carnivores. Facultative carnivores, such as grizzly/brown bears (Ursus arctos), exhibit a variety of behaviors that can lead to the formation of GPS clusters. We combined clustering techniques with field site investigations of grizzly bear GPS locations (n = 732 site investigations; 2004–2011) to produce 174 GPS clusters where documented behavior was partitioned into five classes (large-biomass carcass, small-biomass carcass, old carcass, non-carcass activity, and resting). We used multinomial logistic regression to predict the probability of clusters belonging to each class. Two cross-validation methods—leaving out individual clusters, or leaving out individual bears—showed that correct prediction of bear visitation to large-biomass carcasses was 78–88%, whereas the false-positive rate was 18–24%. As a case study, we applied our predictive model to a GPS data set of 266 bear-years in the Greater Yellowstone Ecosystem (2002–2011) and examined trends in carcass visitation during fall hyperphagia (September–October). We identified 1997 spatial GPS clusters, of which 347 were predicted to be large-biomass carcasses. We used the clustered data to develop a carcass visitation index, which varied annually, but more than doubled during the study period. Our study demonstrates the effectiveness and utility of identifying GPS clusters associated with carcass visitation by a facultative carnivore.

Detecting grizzly bear use of ungulate carcasses using global positioning system telemetry and activity data.

PubMed

Ebinger, Michael R; Haroldson, Mark A; van Manen, Frank T; Costello, Cecily M; Bjornlie, Daniel D; Thompson, Daniel J; Gunther, Kerry A; Fortin, Jennifer K; Teisberg, Justin E; Pils, Shannon R; White, P J; Cain, Steven L; Cross, Paul C

2016-07-01

Global positioning system (GPS) wildlife collars have revolutionized wildlife research. Studies of predation by free-ranging carnivores have particularly benefited from the application of location clustering algorithms to determine when and where predation events occur. These studies have changed our understanding of large carnivore behavior, but the gains have concentrated on obligate carnivores. Facultative carnivores, such as grizzly/brown bears (Ursus arctos), exhibit a variety of behaviors that can lead to the formation of GPS clusters. We combined clustering techniques with field site investigations of grizzly bear GPS locations (n = 732 site investigations; 2004-2011) to produce 174 GPS clusters where documented behavior was partitioned into five classes (large-biomass carcass, small-biomass carcass, old carcass, non-carcass activity, and resting). We used multinomial logistic regression to predict the probability of clusters belonging to each class. Two cross-validation methods-leaving out individual clusters, or leaving out individual bears-showed that correct prediction of bear visitation to large-biomass carcasses was 78-88 %, whereas the false-positive rate was 18-24 %. As a case study, we applied our predictive model to a GPS data set of 266 bear-years in the Greater Yellowstone Ecosystem (2002-2011) and examined trends in carcass visitation during fall hyperphagia (September-October). We identified 1997 spatial GPS clusters, of which 347 were predicted to be large-biomass carcasses. We used the clustered data to develop a carcass visitation index, which varied annually, but more than doubled during the study period. Our study demonstrates the effectiveness and utility of identifying GPS clusters associated with carcass visitation by a facultative carnivore.

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

PubMed

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

2017-02-01

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

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.

Evolution of polyploidy and the diversification of plant-pollinator interactions.

PubMed

Thompson, John N; Merg, Kurt F

2008-08-01

One of the major mechanisms of plant diversification has been the evolution of polyploid populations that differ from their diploid progenitors in morphology, physiology, and environmental tolerances. Recent studies have indicated that polyploidy may also have major effects on ecological interactions with herbivores and pollinators. We evaluated pollination of sympatric diploid and tetraploid plants of the rhizomatous herb Heuchera grossulariifolia (Saxifragaceae) along the Selway and Salmon Rivers of northern Idaho, USA, during four consecutive years. Previous molecular and ecological analyses had indicated that the tetraploid populations along these two river systems are independently derived and differ from each other in multiple traits. In each region, we evaluated floral visitation rate by all insect visitors, pollination efficacy of all major visitors, and relative contribution of all major pollinators to seed set. In both regions, diploid and tetraploid plants attracted different suites of floral visitors. Most pollination was attributable to several bee species and the moth Greya politella. Lasioglossum bees preferentially visited diploid plants at Lower Salmon but not at Upper Selway, queen Bombus centralis preferentially visited tetraploids at both sites, and worker B. centralis differed between sites in their cytotype preference. Hence, diploid and autotetraploid H. grossulariifolia plants act essentially as separate ecological species and may experience partial reproductive isolation through differential visitation and pollination by their major floral visitors. Overall the results, together with recent results from other studies, suggest that the repeated evolution of polyploidy in plants may contribute importantly to the structure and diversification of ecological interactions in terrestrial communities.

Comparative Analysis of Opioid Queries on Erowid.org: An Opportunity to Advance Harm Reduction.

PubMed

Wightman, Rachel S; Perrone, Jeanmarie; Erowid, Fire; Erowid, Earth; Meisel, Zachary F; Nelson, Lewis S

2017-08-24

Many individuals who use opioids turn to online resources to gather information on effects, availability, and safety. Describe opioid index page views on Erowid.org to assess trends in public interest in particular opioids. Retrospective analysis of Erowid.org site traffic was performed to identify unique average daily visits to opioid pages. All data was normalized to that of visits to the heroin index page. Average daily visits to the index pages of each of 6 commonly abused opioids were assessed during the period of 2009 to 2015. Similarly, visits to 15 distinct opioid index pages at 5 time points (July, October 2014 and Jan, April, and July 2015) were described. From 2009 to 2015 a decrease in the number of page visits versus heroin (1.00) occurred for hydrocodone (0.87 to 0.59, -32%), oxycodone (1.38 to 0.99, -28%), and morphine (0.26 to 0.25, -6%). Increases in page visits compared to heroin occurred for fentanyl (0.18 to 0.47, +157%), tramadol (0.43 to 0.88, +106%), hydromorphone (0.19 to 0.24, +29%), and oxymorphone (0.11 to 0.13, +18%). Indexed to heroin (1.00) average opioid page visit frequencies from July 2014 to July 2015 were highest for oxycodone (1.02) and tramadol (0.81). Conclusion/Importance: Oxycodone and tramadol represent the greatest number of Erowid.org opioid page visits compared to heroin. The largest increase in visits over the study periods was for fentanyl and tramadol. The relationship of page visits on Erowid.org creates a unique opportunity for real-time evaluation of emerging drug trends and epidemiological study.

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

A Collection of Papers on Self-Study and Institutional Improvement 1995.

ERIC Educational Resources Information Center

North Central Association of Colleges and Schools, Chicago, IL. Commission on Institutions of Higher Education.

This 11th publication of Annual Meeting papers presents 68 written materials related to invited speakers' oral presentations. The materials address issues of self-study and institutional improvement by institutions of higher education. Chapter 1, "From Self-Study to Site Visit: Case Studies," shares the experiences of a community college…

Scaling up kangaroo mother care in South Africa: 'on-site' versus 'off-site' educational facilitation

PubMed Central

Bergh, Anne-Marie; van Rooyen, Elise; Pattinson, Robert C

2008-01-01

Background Scaling up the implementation of new health care interventions can be challenging and demand intensive training or retraining of health workers. This paper reports on the results of testing the effectiveness of two different kinds of face-to-face facilitation used in conjunction with a well-designed educational package in the scaling up of kangaroo mother care. Methods Thirty-six hospitals in the Provinces of Gauteng and Mpumalanga in South Africa were targeted to implement kangaroo mother care and participated in the trial. The hospitals were paired with respect to their geographical location and annual number of births. One hospital in each pair was randomly allocated to receive either 'on-site' facilitation (Group A) or 'off-site' facilitation (Group B). Hospitals in Group A received two on-site visits, whereas delegates from hospitals in Group B attended one off-site, 'hands-on' workshop at a training hospital. All hospitals were evaluated during a site visit six to eight months after attending an introductory workshop and were scored by means of an existing progress-monitoring tool with a scoring scale of 0–30. Successful implementation was regarded as demonstrating evidence of practice (score >10) during the site visit. Results There was no significant difference between the scores of Groups A and B (p = 0.633). Fifteen hospitals in Group A and 16 in Group B demonstrated evidence of practice. The median score for Group A was 16.52 (range 00.00–23.79) and that for Group B 14.76 (range 07.50–23.29). Conclusion A previous trial illustrated that the implementation of a new health care intervention could be scaled up by using a carefully designed educational package, combined with face-to-face facilitation by respected resource persons. This study demonstrated that the site of facilitation, either on site or at a centre of excellence, did not influence the ability of a hospital to implement KMC. The choice of outreach strategy should be guided by local circumstances, cost and the availability of skilled facilitators. PMID:18651961

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

Abortion misinformation from crisis pregnancy centers in North Carolina.

PubMed

Bryant, Amy G; Levi, Erika E

2012-12-01

This study assessed the accuracy of medical information provided by crisis pregnancy centers in North Carolina. We performed a secondary data analysis of a "secret shopper survey" performed by a nonprofit organization. Reports from phone calls and visits to crisis pregnancy centers were analyzed for quality and content of medical information provided. Web sites of crisis pregnancy centers in the state were also reviewed. Thirty-two crisis pregnancy centers were contacted. Nineteen of these were visited. Fourteen centers (44%) offered that they "provide counseling on abortion and its risks." Inaccurate information provided included a link between abortion and breast cancer (16%), infertility (26%) and mental health problems (26%). Of the 36 Web sites identified, 31 (86%) provided false or misleading information, including 26 sites (72%) linking abortion to "post-abortion stress." Many crisis pregnancy centers give inaccurate medical information regarding the risks of abortion. Overstating risks stigmatizes abortion, seeks to intimidate women and is unethical. Copyright © 2012 Elsevier Inc. All rights reserved.

BOREAS TGB-5 Dissolved Organic Carbon Data from NSA Beaver Ponds

NASA Technical Reports Server (NTRS)

Bourbonniere, Rick; Hall, Forrest G. (Editor); Conrad, Sara K. (Editor)

2000-01-01

The BOReal Ecosystem-Atmosphere Study Trace Gas Biogeochemistry (BOREAS TGB-5) team collected several data sets related to carbon and trace gas fluxes and concentrations in the Northern Study Area (NSA). This data set contains concentrations of dissolved organic and inorganic carbon species from water samples collected at various NSA sites. In particular, this set covers the NSA Tower Beaver Pond Site and the NSA Gillam Road Beaver Pond Site, including data from all visits to open water sampling locations during the BOREAS field campaigns from April to September 1994. The data are provided in tabular ASCII files.

Trail impacts and trail impact management related to ecotourism visitation at Torres del Paine National Park, Chile

USGS Publications Warehouse

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

2002-01-01

Ecotourism and protected area visitation in Central and South America are largely dependent upon a relatively undisturbed quality of natural resources. However, visitation may impact vegetation, soil, water and wildlife resources, and degrade visitor facilities such as recreation sites and trails. Findings are reported from trail impact research conducted at Torres del Paine National Park in Patagonia, Chile. The frequency and magnitude of selected trail impacts and the relative effect of the amount of use, vegetation type, trail position and trail grade are investigated. Findings differed from previous studies in that amount of use was significantly related to both trail width increases and trail erosion. Management actions to minimize trail impacts are offered.

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

Investigating energy-saving potentials in the cloud.

PubMed

Lee, Da-Sheng

2014-02-20

Collecting webpage messages can serve as a sensor for investigating the energy-saving potential of buildings. Focusing on stores, a cloud sensor system is developed to collect data and determine their energy-saving potential. The owner of a store under investigation must register online, report the store address, area, and the customer ID number on the electric meter. The cloud sensor system automatically surveys the energy usage records by connecting to the power company website and calculating the energy use index (EUI) of the store. Other data includes the chain store check, company capital, location price, and the influence of weather conditions on the store; even the exposure frequency of store under investigation may impact the energy usage collected online. After collecting data from numerous stores, a multi-dimensional data array is constructed to determine energy-saving potential by identifying stores with similarity conditions. Similarity conditions refer to analyzed results that indicate that two stores have similar capital, business scale, weather conditions, and exposure frequency on web. Calculating the EUI difference or pure technical efficiency of stores, the energy-saving potential is determined. In this study, a real case study is performed. An 8-dimensional (8D) data array is constructed by surveying web data related to 67 stores. Then, this study investigated the savings potential of the 33 stores, using a site visit, and employed the cloud sensor system to determine the saving potential. The case study results show good agreement between the data obtained by the site visit and the cloud investigation, with errors within 4.17%. Among 33 the samples, eight stores have low saving potentials of less than 5%. The developed sensor on the cloud successfully identifies them as having low saving potential and avoids wasting money on the site visit.

Investigating Energy-Saving Potentials in the Cloud

PubMed Central

Lee, Da-Sheng

2014-01-01

Collecting webpage messages can serve as a sensor for investigating the energy-saving potential of buildings. Focusing on stores, a cloud sensor system is developed to collect data and determine their energy-saving potential. The owner of a store under investigation must register online, report the store address, area, and the customer ID number on the electric meter. The cloud sensor system automatically surveys the energy usage records by connecting to the power company website and calculating the energy use index (EUI) of the store. Other data includes the chain store check, company capital, location price, and the influence of weather conditions on the store; even the exposure frequency of store under investigation may impact the energy usage collected online. After collecting data from numerous stores, a multi-dimensional data array is constructed to determine energy-saving potential by identifying stores with similarity conditions. Similarity conditions refer to analyzed results that indicate that two stores have similar capital, business scale, weather conditions, and exposure frequency on web. Calculating the EUI difference or pure technical efficiency of stores, the energy-saving potential is determined. In this study, a real case study is performed. An 8-dimensional (8D) data array is constructed by surveying web data related to 67 stores. Then, this study investigated the savings potential of the 33 stores, using a site visit, and employed the cloud sensor system to determine the saving potential. The case study results show good agreement between the data obtained by the site visit and the cloud investigation, with errors within 4.17%. Among 33 the samples, eight stores have low saving potentials of less than 5%. The developed sensor on the cloud successfully identifies them as having low saving potential and avoids wasting money on the site visit. PMID:24561405

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

Financial management of large, multi-center trials in a challenging funding milieu.

PubMed

Lovegreen, Olivia; Riggs, Danielle; Staten, Myrlene A; Sheehan, Patricia; Pittas, Anastassios G

2018-05-03

Randomized clinical trials that have public health implications but no or low potential for commercial gain are predominantly funded by governmental (e.g., National Institutes of Health (NIH)) and not-for-profit organizations. Our objective was to develop an alternative clinical trial site funding model for judicious allocation of declining public research funds. In the Vitamin D and Type 2 Diabetes (D2d) study, an NIH-supported, large clinical trial testing the effect of vitamin D supplementation on incident diabetes in 2423 participants at high risk for diabetes, a hybrid financial management model for supporting collaborating clinical sites was developed and applied. The funding model employed two reimbursement components: Core (for study start-up and partial efforts throughout the study, ~40% of the total site budget), invoiced by sites, and Performance-Based Payments (for successful enrollment of participants and completion of follow-up visits, ~60% of the total site budget), automatically issued to the sites by the Coordinating Center based on actual recruitment and visits conducted. Underperforming sites transitioned to Performance-Based Payments only. Recruitment occurred from October 2013 through December 2016, requiring one additional year than the 2-year projection. Median enrollment at each site was 88 participants (range 29-318; 20 to 205% of the site target). At the end of year 1, study-wide recruitment was at 12% of the target (vs. 50% projected) and 12% of the total grant award was invested. The model constantly evaluated sites' needs and re-allocated resources to meet the study enrollment goal. If D2d had issued cost reimbursement subaward agreements and sites invoiced for their entire budget, 83% of the award would have been spent for all study activities over the first 4 years of the trial compared to 65% of the award spent (US$26M) under the hybrid model used by D2d. It is feasible to foster a hybrid financial management approach to steward limited available public funds for research in a dynamic and consistent way that does not compromise the trial's scientific integrity and ensures conservation of funds to complete recruitment and continue to follow up participants.

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...

Effect of Educational Outreach Timing and Duration on Facility Performance for Infectious Disease Care in Uganda: A Trial with Pre-Post and Cluster Randomized Controlled Components

PubMed Central

Burnett, Sarah M.; Mbonye, Martin K.; Naikoba, Sarah; Zawedde-Muyanja, Stella; Kinoti, Stephen N.; Ronald, Allan; Rubashembusya, Timothy; Willis, Kelly S.; Colebunders, Robert; Manabe, Yukari C.; Weaver, Marcia R.

2015-01-01

Background Classroom-based learning is often insufficient to ensure high quality care and application of health care guidelines. Educational outreach is garnering attention as a supplemental method to enhance health care worker capacity, yet there is little information about the timing and duration required to improve facility performance. We sought to evaluate the effects of an infectious disease training program followed by either immediate or delayed on-site support (OSS), an educational outreach approach, on nine facility performance indicators for emergency triage, assessment, and treatment; malaria; and pneumonia. We also compared the effects of nine monthly OSS visits to extended OSS, with three additional visits over six months. Methods This study was conducted at 36 health facilities in Uganda, covering 1,275,960 outpatient visits over 23 months. From April 2010 to December 2010, 36 sites received infectious disease training; 18 randomly selected sites in arm A received nine monthly OSS visits (immediate OSS) and 18 sites in arm B did not. From March 2011 to September 2011, arm A sites received three additional visits every two months (extended OSS), while the arm B sites received eight monthly OSS visits (delayed OSS). We compared the combined effect of training and delayed OSS to training followed by immediate OSS to determine the effect of delaying OSS implementation by nine months. We also compared facility performance in arm A during the extended OSS to immediate OSS to examine the effect of additional, less frequent OSS. Results Delayed OSS, when combined with training, was associated with significant pre/post improvements in four indicators: outpatients triaged (44% vs. 87%, aRR = 1.54, 99% CI = 1.11, 2.15); emergency and priority patients admitted, detained, or referred (16% vs. 31%, aRR = 1.74, 99% CI = 1.10, 2.75); patients with a negative malaria test result prescribed an antimalarial (53% vs. 34%, aRR = 0.67, 99% CI = 0.55, 0.82); and pneumonia suspects assessed for pneumonia (6% vs. 27%, aRR = 2.97, 99% CI = 1.44, 6.17). Differences between the delayed OSS and immediate OSS arms were not statistically significant for any of the nine indicators (all adjusted relative RR (aRRR) between 0.76–1.44, all p>0.06). Extended OSS was associated with significant improvement in two indicators (outpatients triaged: aRR = 1.09, 99% CI = 1.01; emergency and priority patients admitted, detained, or referred: aRR = 1.22, 99% CI = 1.01, 1.38) and decline in one (pneumonia suspects assessed for pneumonia: aRR: 0.93; 99% CI = 0.88, 0.98). Conclusions Educational outreach held up to nine months after training had similar effects on facility performance as educational outreach started within one month post-training. Six months of bi-monthly educational outreach maintained facility performance gains, but incremental improvements were heterogeneous. PMID:26352257

Common Use of Stimulants and Alpha-2 Agonists to Treat Preschool Attention-Deficit Hyperactivity Disorder: A DBPNet Study.

PubMed

Blum, Nathan J; Shults, Justine; Harstad, Elizabeth; Wiley, Susan; Augustyn, Marilyn; Meinzen-Derr, Jareen K; Wolraich, Mark L; Barbaresi, William J

2018-05-30

To describe the use of stimulants and alpha-2 agonists (A2As) for the treatment of preschool-aged children with attention-deficit hyperactivity disorder (ADHD) at 2 Developmental-Behavioral Pediatrics Research Network sites. Demographic information, diagnoses, and medications prescribed by developmental-behavioral pediatricians (DBPs) were extracted from the electronic health record for all outpatient visits from January 1, 2010, to December 31, 2011. The subset of visits for children aged 2 to 5 years who had a diagnosis of ADHD was included in this analysis. Multivariable models were constructed to identify factors associated with prescribing stimulants and A2As. Over the 2-year period, 984 children with a diagnosis of ADHD were seen at 1779 visits. Of the 984 children, 342 (34.8%) were prescribed a stimulant, and 243 (24.7%) were prescribed an A2A. Both medications were prescribed at the same visit at least once during the 2-year period for 97 children (9.9%). Alpha-2 agonists were prescribed more often at site 2 than site 1 (OR [odds ratio] = 1.62, p = 0.015). Stimulants were more likely to be prescribed for older preschool-aged children (OR = 1.66, p < 0.001), and A2As were more likely to be prescribed for younger children (OR = 0.82, p = 0.02). Both stimulants and A2As were more likely to be prescribed to children with ADHD and comorbid conditions. Alpha-2 agonists are commonly used by some DBPs for preschool ADHD. Variation in the use of A2As across sites may indicate a lack of consensus on when to use these medications and suggests a need for comparative effectiveness research to better define the relative benefits and side effects of A2As and stimulants for the treatment of preschool ADHD.

Guidelines for Merit Media Programs.

ERIC Educational Resources Information Center

Kentucky State Dept. of Education, Frankfort. Div. of Instructional Services.

Merit ratings for school media programs that exceed state requirements in Kentucky are explored. Standards for administrative support, facilities, resources, personnel, and programs are provided as well as procedures for conducting a self-study prior to an on-site visit. The self-study instrument which is the major part of the document covers such…

Cooperative Learning and Gifted Students: Report on Five Case Studies.

ERIC Educational Resources Information Center

Coleman, Mary Ruth; And Others

This study examined cooperative learning (CL) programs that were successfully meeting the needs of gifted students and identified factors critical to this success. Of 19 programs nominated as models of cooperative learning, 5 sites were selected and visited: Wilton Public Schools, Connecticut; Glenville Elementary School, Connecticut; Mary Taylor…

Community health workers and smartphones for the detection of surgical site infections in rural Haiti: a pilot study.

PubMed

Matousek, Alexi; Paik, Ken; Winkler, Eric; Denike, Jennifer; Addington, Stephen R; Exe, Chauvet; Louis, Rodolphe R E Jean; Riviello, Robert

2015-04-27

Absence of outcome data is a barrier to quality improvement in resource poor settings. To address this challenge, we set out to determine whether follow up for surgical site infections (SSIs) using community health workers (CHWs) and smartphones is feasible in rural Haiti. In this pilot study, all patients from a specific mountain region who received an operation between March 10, and July 1, 2014, at Hôpital Albert Schweitzer in rural Haiti were eligible for inclusion. Patients or guardians of minors were approached for consent. We designed a smartphone application to enable CHWs to screen for SSIs during home visits by administering a questionnaire, obtaining GPS data, and submitting a photograph of an incision. We selected and trained CHWs to use the smartphone application and compensated them based on performance. CHWs completed home visits for 30 days after an operation for all participants. Surgeons examined all participants within 24 h after the second CHW home visit. Primary outcomes included the number of participants completing 30-day follow-up and home visits made on time. Secondary outcomes included the quality of the photographs and the agreement between surgeons and CHWs on the diagnosis of SSI. The Partners Healthcare institutional review board and the Ethics Committee at Hôpital Albert Schweitzer approved the study protocol. Five CHWs completed 30-day follow up for 37 of 39 participants (94·9%) and completed 107 of 117 home visits on time (91·5%). High quality photographs were submitted for 101 of 117 visits (86·3%). Surgeons and CHWs agreed on the diagnosis of SSI in 28 of 33 cases (84·8%). Outpatient follow up for SSIs with CHWs and smartphones is feasible in rural Haiti. Further validation of the programme needs to be done before widespread adoption or advocating for task shifting post-operative follow up to CHWs. Partners Healthcare, Children's Hospital Boston, and Swiss Bündner Partnerschaft Hôpital Albert Schweitzer Haiti. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

Associations between respiratory illness and PM{sub 10} air pollution

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

Choudhury, A.H.; Gordian, M.E.; Morris, S.S.

In this study, the association between daily morbidity and respirable particulate pollution (i.e., particles with a mass median aerodynamic diameter of {le} 10 microns [PM{sub 10}]) was evaluated in the general population of Anchorage, Alaska. Using insurance claims data for state employees and their dependents who lived in Anchorage, Alaska, the authors determined the number of medical visits for asthma, bronchitis, and upper respiratory infections. The number of visits were related to the level of particulate pollution in ambient air measured at air-monitoring sites. 17 refs., 2 figs., 4 tabs.

Site Characterization for Radar Experiments

DTIC Science & Technology

1990-08-01

accomplished waz "New Mine Detection Technologies," Mr. Jack Stoll, Principal Investigator. The Environmental Systems Division (EST) of the Environmental...Mr. Steve Bong of Hilton Systems visiting the proposed study site in M’rch to select specific locations for the test plots. The field data coll in...Technology/Lincoln Laboratory (MIT/LL) described an airborne 35-Ghz radar imaging system . The MIT/LL would employ various kinds of processing on the

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.

Bradbury

Science.gov Websites

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

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.

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.

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings.

PubMed

Obure, Carol Dayo; Sweeney, Sedona; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Guinness, Lorna; Terris-Prestholt, Fern; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte E; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

2015-01-01

To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider's perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements.

Feasibility of Patient Reporting of Symptomatic Adverse Events via the PRO-CTCAE in a Chemoradiotherapy Cooperative Group Multicenter Clinical Trial

PubMed Central

Basch, Ethan; Pugh, Stephanie L; Dueck, Amylou C; Mitchell, Sandra A; Berk, Lawrence; Fogh, Shannon; Rogak, Lauren J; Gatewood, Marcha; Reeve, Bryce B; Mendoza, Tito R; O’Mara, Ann; Denicoff, Andrea; Minasian, Lori; Bennett, Antonia V; Setser, Ann; Schrag, Deborah; Roof, Kevin; Moore, Joan K; Gergel, Thomas; Stephans, Kevin; Rimner, Andreas; DeNittis, Albert; Bruner, Deborah Watkins

2017-01-01

Purpose To assess the feasibility of measuring symptomatic adverse events (AEs) in a multicenter clinical trial using the National Cancer Institute’s Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Methods and Materials Patients enrolled in Trial XXXX (XXXX) were asked to self-report 53 PRO-CTCAE items representing 30 symptomatic AEs at 6 time points (baseline; weekly x4 during treatment; 12-weeks post-treatment). Reporting was conducted via wireless tablet computers in clinic waiting areas. Compliance was defined as the proportion of visits when an expected PRO-CTCAE assessment was completed. Results Among 226 study sites participating in Trial XXXX, 100% completed 35-minute PRO-CTCAE training for clinical research associates (CRAs); 80 sites enrolled patients of which 34 (43%) required tablet computers to be provided. All 152 patients in Trial XXXX agreed to self-report using the PRO-CTCAE (median age 66; 47% female; 84% white). Median time for CRAs to learn the system was 60 minutes (range 30–240), and median time for CRAs to teach a patient to self-report was 10 minutes (range 2–60). Compliance was high, particularly during active treatment when patients self-reported at 86% of expected time points, although compliance was lower post-treatment (72%). Common reasons for non-compliance were institutional errors such as forgetting to provide computers to participants; patients missing clinic visits; internet connectivity; and patients feeling “too sick”. Conclusions Most patients enrolled in a multicenter chemoradiotherapy trial were willing and able to self-report symptomatic adverse events at visits using tablet computers. Minimal effort was required by local site staff to support this system. The observed causes of missing data may be obviated by allowing patients to self-report electronically between-visits, and by employing central compliance monitoring. These approaches are being incorporated into ongoing studies. PMID:28463161

Explaining the Presence of "Heterosexual" Female Clients of a Rapid HIV Testing Site Located in the Gay Village of Montreal, Quebec.

PubMed

Engler, Kim; Rollet, Kathleen; Lessard, David; Thomas, Réjean; Lebouché, Bertrand

2016-04-01

Increasing access and uptake of HIV testing among at-risk women is needed. Examining women's motives for visiting a community-based rapid HIV testing site (Actuel sur Rue-AsR) oriented to men who have sex with men (MSM) could offer suggestions. To compare the "heterosexual" female and male clients of AsR, located in Montreal's (Canada) gay village, to better understand the women's particular HIV prevention and sexual health service needs. This cross-sectional pilot study analyzed questionnaire data provided by AsR clients and staff (nurse and community agent teams) between July 2012 and November 2013. Women and men reporting only opposite-sex partners were compared with chi-square, Fisher's exact, and Kruskal-Wallis tests, as appropriate, on sociodemographics, HIV-related behaviors, motives for visiting AsR, and health service provision. AsR received 1901 clients. Among these, 55 women and 147 men reported only opposite-sex partners. Women were significantly younger. Significantly greater proportions of women visited AsR because no appointment was necessary (67% vs. 48%), sought testing for condom failure (18% vs. 5%), and had no regular doctor (44% vs. 27%). Both groups mainly chose AsR for the rapid test results (80% and 77%), visited it to receive the rapid HIV test (71% and 76%), and sought testing due to unprotected vaginal sex (44% and 43%). Similar proportions saw the nurse (91% and 89%), received the rapid HIV test (44% and 35%), and were linked to a medical clinic (49% and 52%), especially, to receive complete sexually transmitted infection testing (50% and 44%). The results of this innovative study highlight the draw of rapid HIV testing for "heterosexual" users of a site mainly targeting MSM. They also suggest that further research is warranted into the importance for this group of women clients of drop-in and linkage services, particularly given their possible lesser access to regular care. © The Author(s) 2016.

Treatment of painful radiculopathies with capsaicin 8% cutaneous patch.

PubMed

Baron, R; Treede, R D; Birklein, F; Cegla, T; Freynhagen, R; Heskamp, M L; Kern, K U; Maier, C; Rolke, R; Seddigh, S; Sommer, C; Ständer, S; Maihöfner, C

2017-08-01

The treatment of neuropathic pain due to low-back (lumbosacral) radiculopathies, a common source of neuropathic pain, is challenging and often requires a multimodal therapeutic approach. The capsaicin 8% patch is the first topical analgesic licensed for peripheral neuropathic pain. To evaluate this treatment, a subset of patients with painful radiculopathy (lumbar and cervical, including ventral and dorsal rami) enrolled into the multicenter, non-interventional QUEPP study (Qutenza 2 - safety and effectiveness in peripheral neuropathic pain) was analyzed. Of the 1044 study participants, 50 were diagnosed with painful radiculopathy as only peripheral neuropathic pain syndrome and were eligible for evaluation. Patients received a single treatment (visit 1) with follow-up visits 2-5 at weeks 1-2, 4, 8 and 12. Parameters assessed at all visits included pain intensity, neuropathy symptoms and side effects. Quality of life (SF-12) and painDETECT 1 questionnaires were completed at baseline and final visit. Data was analyzed by patch application site and duration of pain. Topical treatment led to a significant decrease of pain intensity between weeks 1/2 and week 12 versus baseline at the application sites representing dermatomes of ventral (N = 26) and dorsal rami (N = 13) of spinal nerves. A significant decline (p ≤ .001) of numeric pain rating scale scores was observed between weeks 1/2 following patch application and the end of observation (week 12) in the overall radiculopathy group (N = 50), and the groups with either 3 months to 2 years (N = 14) or >2 years (N = 23) duration of pain. Pain relief of at least 30% was observed in 50.0%, 71.4% and 39.1% of patients in the respective groups. Four patients experienced in total seven adverse drug reactions (application site pain or pruritus). Effective neuropathic pain relief was observed after patch application within the innervation territories of both dorsal and ventral branches of the spinal nerve. Further controlled randomized trials are indicated.

Early return visits by pediatric primary care patients with otitis media: a retail nurse practitioner clinic versus standard medical office care.

PubMed

Rohrer, James E; Garrison, Gregory M; Angstman, Kurt B

2012-01-01

To compare outpatient return visits within 2 weeks experienced by pediatric patients diagnosed with otitis media using retail nurse practitioner clinics to similar patients using standard medical office clinics. The impact of retail clinics on return visit rates has not been extensively studied. Electronic medical records of pediatric primary care patients seen in a large group practice in Minnesota in 2009 for otitis media. Patients seen in retail walk-in clinics staffed by nurse practitioners (N = 627) or regular office clinics (N = 2353). A return visit to any site within 2 weeks. The percentage returning was higher in standard care patients than in retail medicine patients (21.0 vs 11.2, P < .001). The odds of a return visit within 2 weeks were higher in standard care patients than in retail medicine patients after adjusting for propensity to use services, age, and gender (odds ratio = 1.54, P < 0.01). In this group practice, the odds of return visits within 2 weeks for pediatric patients treated for otitis media were lower in retail medicine clinics than in standard office clinics.

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

Health Care Human Factors/Ergonomics Fieldwork in Home and Community Settings

PubMed Central

Valdez, Rupa S.; Holden, Richard J.

2017-01-01

Feature at a glance Designing innovations aligned with patients’ needs and workflow requires human factors and ergonomics (HF/E) fieldwork in home and community settings. Fieldwork in these extra-institutional settings is challenged by a need to balance the occasionally competing priorities of patient and informal caregiver participants, study team members, and the overall project. We offer several strategies that HF/E professionals can use before, during, and after home and community site visits to optimize fieldwork and mitigate challenges in these settings. Strategies include interacting respectfully with participants, documenting the visit, managing the study team-participant relationship, and engaging in dialogue with institutional review boards. PMID:28781512

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

ERIC Educational Resources Information Center

Huntington, Gail S.; And Others

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

World Presidents Organization

NASA Technical Reports Server (NTRS)

2010-01-01

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

World Presidents Organization

NASA Image and Video Library

2010-01-26

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

Bradbury Science Museum

Science.gov Websites

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

"I get by with a little help from my friends": A case study in Holy Cross and Grayling using geographic, ethnographic, and biophysical data to tell the story of climate change effects in the lower-middle Yukon River region

NASA Astrophysics Data System (ADS)

Hollingsworth, T. N.; Brown, C.; Cold, H.; Brinkman, T. J.; Brown, D. N.; Verbyla, D.

2017-12-01

Over the last century, Alaska has warmed more than twice as rapidly as the contiguous US. Climate change in boreal Alaska has created new and undocumented vulnerabilities for rural communities. In rural areas, subsistence harvesters rely on established travel networks to access traditional hunting, fishing, and gathering areas. These routes are being affected by ecosystem disturbances, such as thermokarst and increased wildfire severity, linked to climate change. Understanding these changes requires a collaborative effort, using many different forms of data to tell a complete story. Here, we present a case study from Holy Cross and Grayling, Alaska to demonstrate the importance of cross-discipline data integration. Local subsistence users documented GPS coordinates of encountered sites of ecosystem disturbances influencing their access to subsistence areas. These knowledge holders provided the ethnographic, historical and experiential descriptions of the effects of these changes. Then, remote-sensing imagery allows us to look at how these sites change over time. Finally, we returned to collaborate with subsistence users to visit specific sites and quantify the biophysical mechanisms that describe these disturbances. In Holy Cross, we visited areas that recently burned and are undergoing rapid changes in vegetation. We describe the fire regime characteristics such as fire severity, age of site when it burned, pre-fire composition, and post-fire successional trajectory. In Grayling, we visited areas with drying water bodies and associated vegetation change. We describe the current vegetation structure and composition, looked at potential shifts in soil moisture and used repeat imagery to quantify change in water. Our case study exemplifies the power of participatory research, collaboration, and a cross-disciplinary methodology to expand our collective understanding of landscape-level climate-related changes in boreal Alaska.

ASDE-2 Reliability Improvement Study : Volume I. Operational Data and Modification Recommendations.

DOT National Transportation Integrated Search

1974-11-01

Eight airport sites and the FAA Oklahoma Depot were visited and surveys conducted to obtain reliability, maintainability and performance data on the ASDE-2 Radar System. The data was analyzed and recommendations for modification to the equipment made...

ASDE-2 Reliability Improvement Study : Volume II. Modulator, Receiver and Indicator Interface Recommendations

DOT National Transportation Integrated Search

1974-11-01

Eight airport sites and the FAA Oklahoma Depot were visited and surveys conducted to obtain reliability, maintainability and performance data on the ASDE-2 Radar System. The data was analyzed and recommendations for modification to the equipment made...

76 FR 49491 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-10

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Proposed Information Collection Activity; Comment Request Title: Understanding Urban Indians' Interactions with ACF...' Interactions with ACF Programs and Services'' research study, site visits will be conducted to three to five...

Tanzania Health Information Technology (T-HIT) System: Pilot Test of a Tablet-Based System to Improve Prevention of Mother-to-Child Transmission of HIV.

PubMed

Bull, Sheana; Thomas, Deborah Sk; Nyanza, Elias C; Ngallaba, Sospatro E

2018-01-15

The prevention of mother-to-child transmission (PMTCT) of HIV requires innovative solutions. Although routine monitoring is effective in some areas, standardized and easy-to-scale solutions to identify and monitor pregnant women, test them for HIV, and treat them and their children is still lacking. Mobile health (mHealth) offers opportunities for surveillance and reporting in rural areas of low- and middle-income countries. The aim of this study was to document the preliminary impacts of the Tanzania Health Information Technology (T-HIT) system mHealth intervention aimed at health workers for PMTCT care delivery and capacity building in a rural area of Tanzania. We developed T-HIT as a tablet-based system for an electronic data collection system designed to capture and report PMTCT data during antenatal, delivery, and postnatal visits in Misungwi, Tanzania. T-HIT was tested by health workers in a pilot randomized trial comparing seven sites using T-HIT assigned at random to seven control sites; all sites maintained standard paper record-keeping during the pilot intervention period. We compared numbers of antenatal visits, number of HIV tests administered, and women testing positive across all sites. Health workers recorded data from antenatal visits for 1530 women; of these, 695 (45.42%) were tested for HIV and 3.59% (55/1530) tested positive. Health workers were unable to conduct an HIV test for 103 women (6.73%, 103/1530) because of lack of reagent, which is not captured on paper logs. There was no difference in the activity level for testing when comparing sites T-HIT to non-T-HIT sites. We observed a significant postintervention increase in the numbers of women testing positive for HIV compared with the preintervention period (P=.04), but this was likely not attributable to the T-HIT system. T-HIT had a high degree of acceptability and feasibility and is perceived as useful by health workers, who documented more antenatal visits during the pilot intervention compared with a traditional system of paper logs, suggesting potential for improvements in antenatal care for women at risk for HIV. ©Sheana Bull, Deborah SK Thomas, Elias C Nyanza, Sospatro E Ngallaba. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 15.01.2018.

Tanzania Health Information Technology (T-HIT) System: Pilot Test of a Tablet-Based System to Improve Prevention of Mother-to-Child Transmission of HIV

PubMed Central

Bull, Sheana; Nyanza, Elias C; Ngallaba, Sospatro E

2018-01-01

Background The prevention of mother-to-child transmission (PMTCT) of HIV requires innovative solutions. Although routine monitoring is effective in some areas, standardized and easy-to-scale solutions to identify and monitor pregnant women, test them for HIV, and treat them and their children is still lacking. Mobile health (mHealth) offers opportunities for surveillance and reporting in rural areas of low- and middle-income countries. Objective The aim of this study was to document the preliminary impacts of the Tanzania Health Information Technology (T-HIT) system mHealth intervention aimed at health workers for PMTCT care delivery and capacity building in a rural area of Tanzania. Methods We developed T-HIT as a tablet-based system for an electronic data collection system designed to capture and report PMTCT data during antenatal, delivery, and postnatal visits in Misungwi, Tanzania. T-HIT was tested by health workers in a pilot randomized trial comparing seven sites using T-HIT assigned at random to seven control sites; all sites maintained standard paper record-keeping during the pilot intervention period. We compared numbers of antenatal visits, number of HIV tests administered, and women testing positive across all sites. Results Health workers recorded data from antenatal visits for 1530 women; of these, 695 (45.42%) were tested for HIV and 3.59% (55/1530) tested positive. Health workers were unable to conduct an HIV test for 103 women (6.73%, 103/1530) because of lack of reagent, which is not captured on paper logs. There was no difference in the activity level for testing when comparing sites T-HIT to non-T-HIT sites. We observed a significant postintervention increase in the numbers of women testing positive for HIV compared with the preintervention period (P=.04), but this was likely not attributable to the T-HIT system. Conclusions T-HIT had a high degree of acceptability and feasibility and is perceived as useful by health workers, who documented more antenatal visits during the pilot intervention compared with a traditional system of paper logs, suggesting potential for improvements in antenatal care for women at risk for HIV. PMID:29335236

Survival of Implants in Immediate Extraction Sockets of Anterior Teeth: Early Clinical Results.

PubMed

Sabir, Mohammad; Alam, Mohammad Nazish

2015-06-01

The aims and objectives of this study were placement of implants in freshly extracted sockets of anterior teeth and to evaluate the implant stability, peri-implant radiolucency and gingival inflammation around implant over a short period of 30 months. A total of 12 patients (8 male and 4 female), ranging in the age from 20 to 50 years, from March 2007 to June 2007, were evaluated for immediate implant placement into 22 fresh extraction sockets. Only maxillary and mandibular anterior teeth/roots (central incisors, lateral incisors and canines) were considered for replacement with implants. One piece implant with integrated abutment and integrated surface, non-submerged, threaded and tapered at apical 5 mm, sand-blasted and acid etched surfaced implants (HI-TEC TRX-OP Implants of Life Care Company) were used. The mobility was not present in any of the implants at all the follow up visits. There were 2 implants at 6 month, 1 implant at 12 month, 1 implant at 18 month visits, showing peri-implant radiolucency at some sites at bone to implant contact site. Severe gingival inflammation was not observed in any of the implant site. At every follow-up visit, every implant met the criteria of success and none was found to be failed over a 30 months duration i.e. 100% success rate was achieved by implants in immediate extraction socket. The success rate of implant survival in this study was found 100%. These implants have fulfilled all the criteria of implant success and based on the defined criteria, the success rate of implants placed in immediate extraction sockets of anterior teeth compared favorably with the conventional implants. The early results of the present study showed that high survival rates with the implants in immediate extraction sockets can be achieved.

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.

From biofuels to predicting the flu

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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

Climate change and the Arctic

Science.gov Websites

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

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

DOT National Transportation Integrated Search

2011-07-01

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

Tailoring family planning services to the special needs of adolescents.

PubMed

Winter, L; Breckenmaker, L C

1991-01-01

Experimental service protocols tailored to the needs of teenage family planning patients were developed that emphasized indepth counseling, education geared to an adolescent's level of development, and the provision of reassurance and social support. These protocols were tested against usual service delivery practices in a study involving 1,261 patients under 18 years of age at six nonmetropolitan family planning clinics. A comparison with teenagers obtaining services at control sites found that six months after their first clinic visit, patients at the experimental sites were more likely to be using a method, were less likely to experience difficulty in dealing with problems, were more likely to continue using their method despite problems and had learned more during the educational session. Teenage patients at the experimental clinics were also less likely to have become pregnant within one year than those who went to control clinics. Attrition during the year following the first study visit was similar among both groups; patient satisfaction was very high, and equivalent at experimental and control sites. The data show that the extra time and effort required to meet the special needs of teenagers is justified by their improved contraceptive use, greater knowledge and lower pregnancy rates.

A Study of English Language Training for Refugees. Public Report.

ERIC Educational Resources Information Center

Reder, Stephen; And Others

The final report of a study on the impact of English language training on adult Southeast Asian refugees in the United States summarizes the findings of the study's three phases, which include (1) a mail survey of local, regional, and state program administrators; (2) 22 program site visits and four community surveys; and (3) a six-month…

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…

77 FR 35059 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Job Corps...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-12

... for OMB Review; Comment Request; Job Corps Process Study ACTION: Notice. SUMMARY: The Department of... collection request (ICR) proposal titled, ``Job Corps Process Study,'' to the Office of Management and Budget... conduct site visits to Job Corps centers and a survey of center directors for a process study of the Job...

Inverting the Object of Study: Recalibrating the Frame of Reference in Study Abroad Experiences

ERIC Educational Resources Information Center

Palmer, Norris W.

2015-01-01

This essay is concerned with study abroad experiences as opportunities for student cognitive development, using the interpretive lens of educational psychologist William G. Perry. A standard and often valuable assignment in courses on world religions is a site visit to a religious institution in one's local area. This may concretize otherwise…

Intercultural Learning on Short-Term Sojourns

ERIC Educational Resources Information Center

Jackson, Jane

2009-01-01

This paper presents an ethnographic case study of advanced second language (L2) students from Hong Kong who took part in a short-term sojourn in England after 14 weeks of preparation. While abroad, they lived with a host family, took literary/cultural studies courses, visited cultural sites, participated in debriefing sessions, and conducted…

75 FR 78212 - Proposed Information Collection; Comment Request; Center for Economic Studies Research Proposal...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-15

... Economic Studies Research Proposal Process and Project Management AGENCY: U.S. Census Bureau, Commerce... Project Management System by visiting the CES Web site ( http://www.ces.census.gov/index/php ) and click...) and instructions should be directed to Dr. Brian P. Holly, Project Review Coordinator, Center for...

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…

A Study Tour of India.

ERIC Educational Resources Information Center

French, Shirley

1992-01-01

Describes 1991 site visits by British educational administrators of early childhood educational institutions in Delhi and Bombay, India. Discusses philosophies and practices witnessed at a national center providing preschool education and meals, a mobile day-care center for children of migrant workers, a preschool teacher training institute, and…

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…

From Extrinsic Guidance toward Student Self-Control.

ERIC Educational Resources Information Center

Geary, William T.

This ethnographic study examined conditions affecting how six elementary teachers who were involved in an ongoing inservice program embraced, comprehended, and applied elements of classroom management via cooperative learning. The paper described factors that helped and hindered their attempts. Data collection included site visits with…

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

PubMed

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

2003-02-01

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

10 CFR 40.5 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

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

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

DOT National Transportation Integrated Search

2006-07-01

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

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.

Ultrasonographic evaluation of the canine urinary bladder following cystotomy for treatment of urolithiasis.

PubMed

Mariano, Abigail D; Penninck, Dominique G; Sutherland-Smith, James; Kudej, Raymond K

2018-05-01

OBJECTIVE To describe the ultrasonographic appearance of the urinary bladder incision site in dogs that underwent cystotomy for treatment of urolithiasis. DESIGN Prospective, longitudinal study. ANIMALS 18 client-owned dogs. PROCEDURES Dogs underwent urinary bladder ultrasonography at baseline (≤ 1 day before surgery) and at 1 day and approximately 2, 6, and 12 weeks after cystotomy for urocystolith removal. A baseline ratio between ventral (cystotomy site) and corresponding dorsal midline wall thickness was calculated and used to account for measurement variations attributable to bladder distension at subsequent visits. Patient signalment, weight, medications administered, urocystolith composition, and culture results were recorded. Clinical signs, reoccurrence of hyperechoic foci, and suture visualization were recorded at follow-up examinations. Variables were evaluated for association with cystotomy site thickening and resolution of thickening. RESULTS Median wall thickness at the ventral aspect of the bladder was significantly greater than that of the corresponding dorsal aspect at baseline. Cystotomy site thickening peaked 1 day after surgery and decreased at subsequent visits in a linear manner. Twelve weeks after surgery, 5 of 10 clinically normal dogs evaluated had persistent cystotomy site thickening. Eleven of 18 dogs had reoccurrence of hyperechoic foci within the bladder at some time during the study (median time to first detection, 17 days after surgery). CONCLUSIONS AND CLINICAL RELEVANCE Persistent cystotomy site thickening can be present up to 3 months after cystotomy for urolithiasis in dogs without lower urinary tract signs. Reoccurrence of hyperechoic foci in the bladder, although subclinical, was detected earlier and at a higher rate than anticipated.

10 CFR 70.5 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

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

Water Developments and Canids in Two North American Deserts: A Test of the Indirect Effect of Water Hypothesis

PubMed Central

Hall, Lucas K.; Larsen, Randy T.; Knight, Robert N.; Bunnell, Kevin D.; McMillan, Brock R.

2013-01-01

Anthropogenic modifications to landscapes intended to benefit wildlife may negatively influence wildlife communities. Anthropogenic provisioning of free water (water developments) to enhance abundance and distribution of wildlife is a common management practice in arid regions where water is limiting. Despite the long-term and widespread use of water developments, little is known about how they influence native species. Water developments may negatively influence arid-adapted species (e.g., kit fox, Vulpes macrotis) by enabling water-dependent competitors (e.g., coyote, Canis latrans) to expand distribution in arid landscapes (i.e., indirect effect of water hypothesis). We tested the two predictions of the indirect effect of water hypothesis (i.e., coyotes will visit areas with free water more frequently and kit foxes will spatially and temporally avoid coyotes) and evaluated relative use of free water by canids in the Great Basin and Mojave Deserts from 2010 to 2012. We established scent stations in areas with (wet) and without (dry) free water and monitored visitation by canids to these sites and visitation to water sources using infrared-triggered cameras. There was no difference in the proportions of visits to scent stations in wet or dry areas by coyotes or kit foxes at either study area. We did not detect spatial (no negative correlation between visits to scent stations) or temporal (no difference between times when stations were visited) segregation between coyotes and kit foxes. Visitation to water sources was not different for coyotes between study areas, but kit foxes visited water sources more in Mojave than Great Basin. Our results did not support the indirect effect of water hypothesis in the Great Basin or Mojave Deserts for these two canids. PMID:23844097

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

ERIC Educational Resources Information Center

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

2010-01-01

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

Police Burglary Prevention Programs.

ERIC Educational Resources Information Center

White, Thomas W.; And Others

The study is designed to assist police and other law enforcement agencies, as well as local government officials, in planning new burglary prevention activities and modifying existing ones. Information was compiled from (1) a survey of 50 United States police departments, (2) site visits to 12 departments with operating burglary prevention…

Manufacturing Advantage: Why High-Performance Work Systems Pay Off.

ERIC Educational Resources Information Center

Appelbaum, Eileen; Bailey, Thomas; Berg, Peter; Kalleberg, Arne L.

A study examined the relationship between high-performance workplace practices and the performance of plants in the following manufacturing industries: steel, apparel, and medical electronic instruments and imaging. The multilevel research methodology combined the following data collection activities: (1) site visits; (2) collection of plant…

Great Lake beach-goer behavior during a retrospectively detected bloom of cyanobacteria

EPA Science Inventory

Cyanobacteria blooms pose a potential health risk to beachgoers. We conducted a prospective study of weekend beachgoers at a public Great Lake site during July – September 2003. We recorded each person’s health status and activity during their beach visit. We measured...

The Potential Influence of Bumble Bee Visitation on Foraging Behaviors and Assemblages of Honey Bees on Squash Flowers in Highland Agricultural Ecosystems

PubMed Central

Xie, Zhenghua; Pan, Dongdong; Teichroew, Jonathan; An, Jiandong

2016-01-01

Bee species interactions can benefit plant pollination through synergistic effects and complementary effects, or can be of detriment to plant pollination through competition effects by reducing visitation by effective pollinators. Since specific bee interactions influence the foraging performance of bees on flowers, they also act as drivers to regulate the assemblage of flower visitors. We selected squash (Cucurbita pepo L.) and its pollinators as a model system to study the foraging response of honey bees to the occurrence of bumble bees at two types of sites surrounded by a high amount of natural habitats (≥ 58% of land cover) and a low amount of natural habitats (≤ 12% of land cover) in a highland agricultural ecosystem in China. At the individual level, we measured the elapsed time from the departure of prior pollinator(s) to the arrival of another pollinator, the selection of honey bees for flowers occupied by bumble bees, and the length of time used by honey bees to explore floral resources at the two types of sites. At the community level, we explored the effect of bumble bee visitation on the distribution patterns of honey bees on squash flowers. Conclusively, bumble bee visitation caused an increase in elapsed time before flowers were visited again by a honey bee, a behavioral avoidance by a newly-arriving honey bee to select flowers occupied by bumble bees, and a shortened length of time the honey bee takes to examine and collect floral resources. The number of overall bumble bees on squash flowers was the most important factor explaining the difference in the distribution patterns of honey bees at the community level. Furthermore, decline in the number of overall bumble bees on the squash flowers resulted in an increase in the number of overall honey bees. Therefore, our study suggests that bee interactions provide an opportunity to enhance the resilience of ecosystem pollination services against the decline in pollinator diversity. PMID:26765140

The Potential Influence of Bumble Bee Visitation on Foraging Behaviors and Assemblages of Honey Bees on Squash Flowers in Highland Agricultural Ecosystems.

PubMed

Xie, Zhenghua; Pan, Dongdong; Teichroew, Jonathan; An, Jiandong

2016-01-01

Bee species interactions can benefit plant pollination through synergistic effects and complementary effects, or can be of detriment to plant pollination through competition effects by reducing visitation by effective pollinators. Since specific bee interactions influence the foraging performance of bees on flowers, they also act as drivers to regulate the assemblage of flower visitors. We selected squash (Cucurbita pepo L.) and its pollinators as a model system to study the foraging response of honey bees to the occurrence of bumble bees at two types of sites surrounded by a high amount of natural habitats (≥ 58% of land cover) and a low amount of natural habitats (≤ 12% of land cover) in a highland agricultural ecosystem in China. At the individual level, we measured the elapsed time from the departure of prior pollinator(s) to the arrival of another pollinator, the selection of honey bees for flowers occupied by bumble bees, and the length of time used by honey bees to explore floral resources at the two types of sites. At the community level, we explored the effect of bumble bee visitation on the distribution patterns of honey bees on squash flowers. Conclusively, bumble bee visitation caused an increase in elapsed time before flowers were visited again by a honey bee, a behavioral avoidance by a newly-arriving honey bee to select flowers occupied by bumble bees, and a shortened length of time the honey bee takes to examine and collect floral resources. The number of overall bumble bees on squash flowers was the most important factor explaining the difference in the distribution patterns of honey bees at the community level. Furthermore, decline in the number of overall bumble bees on the squash flowers resulted in an increase in the number of overall honey bees. Therefore, our study suggests that bee interactions provide an opportunity to enhance the resilience of ecosystem pollination services against the decline in pollinator diversity.

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

PubMed Central

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

2018-01-01

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

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

PubMed

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

2018-01-01

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

Practical tool to assess reliability of web-based medicines information.

PubMed

Lebanova, Hristina; Getov, Ilko; Grigorov, Evgeni

2014-02-01

Information disseminated by medicines information systems is not always easy to apply. Nowadays internet provides access to enormous volume and range of health information that was previously inaccessible both for medical specialists and consumers. The aim of this study is to assess internet as a source of drug and health related information and to create test methodology to evaluate the top 10 visited health-related web-sites in Bulgaria. Using existing scientific methodologies for evaluation of web sources, a new algorithm of three-step approach consisting of score-card validation of the drug-related information in the 10 most visited Bulgarian web-sites was created. In many cases the drug information in the internet sites contained errors and discrepancies. Some of the published materials were not validated; they were out-of-date and could cause confusion for consumers. The quality of the online health information is a cause for considerable information noise and threat to patients' safety and rational drug use. There is a need of monitoring the drugs information available online in order to prevent patient misinformation and confusion that could lead to medication errors and abuse.

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

PubMed Central

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

2017-01-01

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

Antibiotic treatment of acute respiratory infections in acute care settings.

PubMed

Gonzales, Ralph; Camargo, Carlos A; MacKenzie, Thomas; Kersey, Ayanna S; Maselli, Judith; Levin, Sara K; McCulloch, Charles E; Metlay, Joshua P

2006-03-01

To examine the patterns of antibiotic use for acute respiratory tract infections (ARIs) in acute care settings. Chart reviews were performed retrospectively on a random sample of adult ARI visits to seven Veterans Affairs (VA) and seven non-VA emergency departments (EDs) for the period of November 2003 to February 2004. Visits were limited to those discharged to home and those with primary diagnoses of antibiotic-responsive (pneumonia, acute exacerbation of chronic bronchitis, pharyngitis, sinusitis) and antibiotic-nonresponsive conditions (acute bronchitis, nonspecific upper respiratory tract infection [URI]). Results are expressed as adjusted odds ratios with 95% confidence intervals. Of 2,270 ARI visits, 62% were for antibiotic-nonresponsive diagnoses. Seventy-two percent of acute bronchitis and 38% of URI visits were treated with antibiotics (p < 0.001). Stratified analyses show that antibiotic prescription rates were similar among attending-only and housestaff-associated visits for antibiotic-responsive diagnoses (p = 0.11), and acute bronchitis (76% vs. 59%; p = 0.31). However, the antibiotic prescription rate for URIs was greater for attending-only visits compared with housestaff-associated visits (48% vs. 15%; p = 0.01). Antibiotic prescription rates for total ARIs varied between sites, ranging from 42% to 89%. Patient age, gender, race and ethnicity, smoking status, comorbidities, and clinical setting (VA vs. non-VA) were not independently associated with antibiotic prescribing. Acute care settings are important targets for reducing inappropriate antibiotic prescribing. The mechanisms accounting for lower antibiotic prescription rates observed with housestaff-associated visits merit further study.

Congressman Clyburn Visit

ScienceCinema

Cody, Tom

2017-12-13

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

75 FR 51081 - National Advisory Committee on Rural Health and Human Services; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-18

... the three chosen Subcommittee topics. The first panel will focus on Childhood Obesity in Rural... break into Subcommittees and depart to the site visits. The Childhood Obesity Subcommittee will visit... is Rural Early Childhood Development Place-Based Initiatives. After the panel discussions, the...

75 FR 20885 - National Park Week, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-21

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

Expedition 52 Red Square Visit

NASA Image and Video Library

2017-07-10

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

Expedition 50 Red Square Visit

NASA Image and Video Library

2016-10-26

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

Expedition 52 Red Square Visit

NASA Image and Video Library

2017-07-10

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

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

DOT National Transportation Integrated Search

2009-01-01

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

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

PubMed Central

Pacheco, Diego Andrés; Dudley, Leah S

2017-01-01

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

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

PubMed

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

2013-02-01

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

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

PubMed

Jankowski, Irene M; Nadzam, Deborah Morris

2011-06-01

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

10 CFR 74.6 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

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

10 CFR 74.6 - Communications.

Code of Federal Regulations, 2012 CFR

2012-01-01

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

10 CFR 25.9 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

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

10 CFR 25.9 - Communications.

Code of Federal Regulations, 2012 CFR

2012-01-01

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

Use of Telehealth for Research and Clinical Measures in Cochlear Implant Recipients: A Validation Study

ERIC Educational Resources Information Center

Hughes, Michelle L.; Goehring, Jenny L.; Baudhuin, Jacquelyn L.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger; Valente, Daniel L.

2012-01-01

Purpose: The goal of this study was to compare clinical and research-based cochlear implant (CI) measures using telehealth versus traditional methods. Method: This prospective study used an ABA design (A = laboratory, B = remote site). All measures were made twice per visit for the purpose of assessing within-session variability. Twenty-nine adult…

Sexuality and the Internet: A Study of the Perspectives of Turkish University Students.

PubMed

Ucar, Tuba; Golbasi, Zehra; Senturk Erenel, Ayten

2016-12-01

The purpose of this study was to determine Turkish university students' uses of and attitudes toward the Internet concerning sexuality. The study was conducted in two public universities in the Central Anatolia and Eastern Anatolia regions of Turkey. Among the students invited to take part in the study, 1,330 students agreed to do so. The study data were collected using a questionnaire designed by researchers to determine participants' personal characteristics, computer and Internet uses in general, and for sexual matters. The findings suggest that approximately half of the students (51%) reported using the Internet to obtain information about sexuality. Among the students, 30.5% said that they visit erotic and pornographic Web sites, 21.1% said that they chat on the Internet about sexuality, and 9.3% said that they bought sexual products online. Compared to the female students, the male students, statistically, more frequently show behaviors such as obtaining sexual information on the Internet, online sexual shopping, chatting on the Internet about sexuality, and visiting pornographic and erotic Web sites. In addition, female students have more negative attitudes toward using the Internet for sexual purposes. This study discusses its results along with the literature from Turkey and other countries.

Periodontal disease among 45-54 year olds in Adelaide, South Australia.

PubMed

Brennan, D S; Spencer, A J; Roberts-Thomson, K F

2007-03-01

The aims of this study were to describe the prevalence, extent and severity of periodontal disease among middle-aged adults, and to examine periodontitis by dental visit pattern, dental and health behaviour, socio-demographics and socioeconomic status. A random sample of 45-54 year olds from metropolitan Adelaide, South Australia was surveyed by mailed self-complete questionnaire during 2004-2005 with up to four follow-up mailings of the questionnaire to non-respondents (n=879 responded, response rate = 43.8 per cent). Oral examinations were performed on 709 people who responded to the questionnaire (completion rate=80.7 per cent), providing an assessment of periodontal status. Prevalence of loss of attachment (LOA) of 6+ mm was 19.2 per cent, extent of sites with LOA of 6+ mm was 1.3 per cent, and severity of LOA of sites with LOA of 2+ mm was 2.4mm. Using a case definition for periodontitis of two or more sites with LOA of 5+ mm and one or more sites with PD of 4+ mm in a multivariate logistic regression showed higher odds of periodontitis for people who last visited for relief of pain (OR = 1.93) and who smoked daily/occasionally (OR = 3.84), while lower odds were observed for people who were born in Australia (OR = 0.51) and spoke English as the main language at home (OR = 0.34). While periodontal disease was related to visit pattern and health-related behaviours, the relationship with place of birth and main language spoken at home indicated socio-cultural variation in disease not explained by behaviour among this cohort of 45-54 year olds.

Food Defense Practices of School Districts in Northern U.S. States

ERIC Educational Resources Information Center

Klitzke, Carol J.

2013-01-01

This study assessed implementation of food defense practices in public schools in Montana, Wyoming, South Dakota, North Dakota, Iowa, Minnesota, and Wisconsin. The first phase involved a qualitative multi-site case study: one-day visits were made to five school districts in the states of Iowa, South Dakota, Minnesota, and Wisconsin. A principal,…

Modification of Point Counts for Surveying Cropland Birds

Treesearch

Kathryn Freemark; Catherine Rogers

1995-01-01

As part of a comparative study of agricultural impacts on wildlife, modifications to the point count method were evaluated for surveying birds in, and adjacent to, cropland during the breeding season (May to early July) in Ontario. Location in the field, observation direction and distance, number of visits, and number of study sites per farm were examined using point...

Use characteristics of the great gulf wilderness

Treesearch

R. E. Leonard; H. E. Echelberger; M. Schnitzer

1978-01-01

Three use characteristics were studied in the Great Gulf Wilderness of the White Mountain National Forest in 1976: (1) use quantity; (2) use distribution; (3) overnight use patterns. Pressure-plate counters, in conjunction with use permits and site observations, were used to acquire data. Approximately 4,000 people visited this area during the 56-day study period; 75...

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

PubMed

Bolek, Siegfried; Wittlinger, Matthias; Wolf, Harald

2012-09-15

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

The Reimer Diatom Herbarium: An important resource for teaching and research

USGS Publications Warehouse

Rushforth, S.J.; Edlund, M.B.; Spaulding, S.A.; Stoermer, E.F.

2010-01-01

The Reimer Diatom Herbarium (ILH) at Iowa Lakeside Laboratory (ILL), a field station of Iowa's state universities, contains 3,280 permanent diatom slides of collections made from prairie potholes, alkaline fens, acid bogs, eutrophic lakes, saline lakes, Pleistocene paleolakes, and Miocene fossil deposits near ILL. The herbarium has a focus on collections made within Dickinson County, a region with an important legacy of study by students and visiting researchers from the US, Canada, and international institutions. The herbarium is well documented by taxon and location catalogues. The taxon card catalogue contains over 2,800 records referencing 67 genera, and the location card catalogue references collection sites from 51 counties in 16 North American states. Curated slides include over 300 species identifications made, or verified, by C.W. Reimer. Most curated slides have diatom specimens identified to species, circled with a diamond objective marker, and indicated on the slide label Six holotypes are included in the herbarium and we present the first light micrograph images of these type specimens. We present documentation of the contents and current condition of the herbarium and report that it is now available to researchers for scientific study. Many of the sites represented in the Reimer Diatom Herbarium are the same locations visited each year by students and visiting researchers at ILL, resulting in an important resource for monitoring environmental change, resolving taxonomic issues, and understanding species distributions in unique habitats.

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.

Collaboration for Instruction of LEP Students in Vocational Education.

ERIC Educational Resources Information Center

Platt, Elizabeth; And Others

A study examined the collaboration between vocational teachers and their colleagues in vocational English as a Second Language (VESL) or English as a second language (ESL) on behalf of limited English proficient (LEP) students in mainstream vocational classrooms. Visits were made to three secondary and three postsecondary sites nationwide. Data…

78 FR 15975 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Job Clubs...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-13

... DEPARTMENT OF LABOR Office of the Secretary Agency Information Collection Activities; Submission for OMB Review; Comment Request; Job Clubs Study ACTION: Notice; correction. SUMMARY: The Department... comments on site visits to job clubs. The document contained incorrect dates. FOR FURTHER INFORMATION...

Self-Guided Field Trips for Students of Environments

ERIC Educational Resources Information Center

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

2011-01-01

In many learning institutions around the world, there is a trend towards larger classes, more flexible learning pathways and reduced teaching resources. Experiential learning is often used in the form of site visits or field trips for students studying engineering, natural resource management, geography and similar disciplines. Providing…

Job Search as Goal-Directed Behavior: Objectives and Methods

ERIC Educational Resources Information Center

Van Hoye, Greet; Saks, Alan M.

2008-01-01

This study investigated the relationship between job search objectives (finding a new job/turnover, staying aware of job alternatives, developing a professional network, and obtaining leverage against an employer) and job search methods (looking at job ads, visiting job sites, networking, contacting employment agencies, contacting employers, and…

10 CFR Appendix A to Subpart D of... - Categorical Exclusions Applicable to General Agency Actions

Code of Federal Regulations, 2012 CFR

2012-01-01

... agreements for energy research and development A1Routine DOE business actions Routine actions necessary to... dissemination Information gathering (including, but not limited to, literature surveys, inventories, site visits... (including, but not limited to, conceptual design, feasibility studies, and analytical energy supply and...

10 CFR Appendix A to Subpart D of... - Categorical Exclusions Applicable to General Agency Actions

Code of Federal Regulations, 2014 CFR

2014-01-01

... International agreements for energy research and development A1 Routine DOE business actions Routine actions... dissemination Information gathering (including, but not limited to, literature surveys, inventories, site visits... (including, but not limited to, conceptual design, feasibility studies, and analytical energy supply and...

10 CFR Appendix A to Subpart D of... - Categorical Exclusions Applicable to General Agency Actions

Code of Federal Regulations, 2013 CFR

2013-01-01

... agreements for energy research and development A1Routine DOE business actions Routine actions necessary to... dissemination Information gathering (including, but not limited to, literature surveys, inventories, site visits... (including, but not limited to, conceptual design, feasibility studies, and analytical energy supply and...

An Evaluation of the Servicemen's Opportunity College.

ERIC Educational Resources Information Center

Nolan, David M.; Casserly, Patricia Lund

This study presents a preliminary evaluation of the Servicemen's Opportunity College (SOC) program. Data were obtained from the site visits and a mailed survey. Results indicated: (1) The college personnel accepted the military students as a natural part of their constituency and often commented about them as being superior to the civilian…

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

PubMed

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

2012-01-01

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

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

PubMed Central

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

2012-01-01

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

Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits.

PubMed

Schoenfeld, Adam J; Davies, Jason M; Marafino, Ben J; Dean, Mitzi; DeJong, Colette; Bardach, Naomi S; Kazi, Dhruv S; Boscardin, W John; Lin, Grace A; Duseja, Reena; Mei, Y John; Mehrotra, Ateev; Dudley, R Adams

2016-05-01

Commercial virtual visits are an increasingly popular model of health care for the management of common acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously-via videoconference, telephone, or webchat-to a physician with whom they have no prior relationship. To date, whether the care delivered through those websites is similar or quality varies among the sites has not been assessed. To assess the variation in the quality of urgent health care among virtual visit companies. This audit study used 67 trained standardized patients who presented to commercial virtual visit companies with the following 6 common acute illnesses: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent female urinary tract infection. The 8 commercial virtual visit websites with the highest web traffic were selected for audit, for a total of 599 visits. Data were collected from May 1, 2013, to July 30, 2014, and analyzed from July 1, 2014, to September 1, 2015. Completeness of histories and physical examinations, the correct diagnosis (vs an incorrect or no diagnosis), and adherence to guidelines of key management decisions. Sixty-seven standardized patients completed 599 commercial virtual visits during the study period. Histories and physical examinations were complete in 417 visits (69.6%; 95% CI, 67.7%-71.6%); diagnoses were correctly named in 458 visits (76.5%; 95% CI, 72.9%-79.9%), and key management decisions were adherent to guidelines in 325 visits (54.3%; 95% CI, 50.2%-58.3%). Rates of guideline-adherent care ranged from 206 visits (34.4%) to 396 visits (66.1%) across the 8 websites. Variation across websites was significantly greater for viral pharyngitis and acute rhinosinusitis (adjusted rates, 12.8% to 82.1%) than for streptococcal pharyngitis and low back pain (adjusted rates, 74.6% to 96.5%) or ankle pain and recurrent urinary tract infection (adjusted rates, 3.4% to 40.4%). No statistically significant variation in guideline adherence by mode of communication (videoconference vs telephone vs webchat) was found. Significant variation in quality was found among companies providing virtual visits for management of common acute illnesses. More variation was found in performance for some conditions than for others, but no variation by mode of communication.

Ménière's Disease: A CHEER Database Study of Local and Regional Patient Encounter and Procedure Patterns.

PubMed

Crowson, Matthew G; Schulz, Kristine; Parham, Kourosh; Vambutas, Andrea; Witsell, David; Lee, Walter T; Shin, Jennifer J; Pynnonen, Melissa A; Nguyen-Huynh, Anh; Ryan, Sheila E; Langman, Alan

2016-07-01

(1) Integrate practice-based patient encounters using the Dartmouth Atlas Medicare database to understand practice treatments for Ménière's disease (MD). (2) Describe differences in the practice patterns between academic and community providers for MD. Practice-based research database review. CHEER (Creating Healthcare Excellence through Education and Research) network academic and community providers. MD patient data were identified with ICD-9 and CPT codes. Demographics, unique visits, and procedures per patient were tabulated. The Dartmouth Atlas of Health Care was used to reference regional health care utilization. Statistical analysis included 1-way analyses of variance, bivariate linear regression, and Student's t tests, with significance set at P < .05. A total of 2071 unique patients with MD were identified from 8 academic and 10 community otolaryngology-head and neck surgery provider centers nationally. Average age was 56.5 years; 63.9% were female; and 91.4% self-reported white ethnicity. There was an average of 3.2 visits per patient. Western providers had the highest average visits per patient. Midwest providers had the highest average procedures per patient. Community providers had more visits per site and per patient than did academic providers. Academic providers had significantly more operative procedures per site (P = .0002) when compared with community providers. Health care service areas with higher total Medicare reimbursements per enrollee did not report significantly more operative procedures being performed. This is the first practice-based clinical research database study to describe MD practice patterns. We demonstrate that academic otolaryngology-head and neck surgery providers perform significantly more operative procedures than do community providers for MD, and we validate these data with an independent Medicare spending database. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

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.

The use of on-site visits to assess compliance and implementation of quality management at hospital level.

PubMed

Wagner, C; Groene, O; Dersarkissian, M; Thompson, C A; Klazinga, N S; Arah, O A; Suñol, R

2014-04-01

Stakeholders of hospitals often lack standardized tools to assess compliance with quality management strategies and the implementation of clinical quality activities in hospitals. Such assessment tools, if easy to use, could be helpful to hospitals, health-care purchasers and health-care inspectorates. The aim of our study was to determine the psychometric properties of two newly developed tools for measuring compliance with process-oriented quality management strategies and the extent of implementation of clinical quality strategies at the hospital level. We developed and tested two measurement instruments that could be used during on-site visits by trained external surveyors to calculate a Quality Management Compliance Index (QMCI) and a Clinical Quality Implementation Index (CQII). We used psychometric methods and the cross-sectional data to explore the factor structure, reliability and validity of each of these instruments. The sample consisted of 74 acute care hospitals selected at random from each of 7 European countries. The psychometric properties of the two indices (QMCI and CQII). Overall, the indices demonstrated favourable psychometric performance based on factor analysis, item correlations, internal consistency and hypothesis testing. Cronbach's alpha was acceptable for the scales of the QMCI (α: 0.74-0.78) and the CQII (α: 0.82-0.93). Inter-scale correlations revealed that the scales were positively correlated, but distinct. All scales added sufficient new information to each main index to be retained. This study has produced two reliable instruments that can be used during on-site visits to assess compliance with quality management strategies and implementation of quality management activities by hospitals in Europe and perhaps other jurisdictions.

Case Studies of Schools Receiving School Improvement Grants: Findings after the First Year of Implementation. NCEE 2014-4015

ERIC Educational Resources Information Center

Le Floch, Kerstin Carlson; Birman, Beatrice; O'Day, Jennifer; Hurlburt, Steven; Mercado-Garcia, Diana; Goff, Rose; Manship, Karen; Brown, Seth; Therriault, Susan Bowles; Rosenberg, Linda; Angus, Megan Hague; Hulsey, Lara

2014-01-01

The Study of School Turnaround examines the improvement process in a purposive sample of 35 case study schools receiving federal School Improvement Grants (SIG) over a three-year period (2010-11 to 2012-13 school years). Using site visit, teacher survey, and fiscal data, the case studies describe the school contexts, the principals' leadership…

Geothermal energy in Tibet

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

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

1984-09-01

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

STS-133 crew visit

NASA Image and Video Library

2011-04-20

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

Increasing Efficiency of Recruitment in Early Parkinson's Disease Trials: A Case Study Examination of the STEADY-PD III Trial.

PubMed

Berk, Sarah; Greco, Brittany L; Biglan, Kevin; Kopil, Catherine M; Holloway, Robert G; Meunier, Claire; Simuni, Tanya

2017-01-01

Challenges in clinical trial recruitment threaten the successful development of improved therapies. This is particularly true in Parkinson's disease (PD) studies of disease modification where the population of interest is difficult to find and study design is more complex. This paper seeks to understand how STEADY PD III, a National Institute of Neurological Disorders and Stroke (NINDS) funded phase 3 trial evaluating the efficacy of isradipine as a disease modifying agent for PD, was able to recruit their full target population 6 months ahead of schedule. STEADY PD III aimed to enroll 336 individuals with early stage idiopathic PD within 18 months using 57 sites across the United States and Canada. The study included a 10% NIH minority recruitment goal. Eligible participants agreed to be followed for up to 36 months, complete 12 in-person visits and 4 telephone visits. A Recruitment Committee of key stakeholders was critical in the development of a comprehensive recruitment strategy involving: multi-modal outreach, protocol modifications and comprehensive site selection and activation. Efforts to increase site-specific minority recruitment strategies were encouraged through additional funding. A total of 336 individuals, including 34 minorities, were enrolled within 12 months - 6 months ahead of the projected timeline. Quantitative analysis of recruitment activity questionnaires found that of the sites that completed them (n = 54), (20.4%) met goals, (24.1%) exceeded goals, and (55.6%) fell below projected goals. Referral sources completed at time of screening indicate top four study referral sources as: site personnel (53.8%); neurologists (24%); Fox Trial Finder (10.2%); and communications from The Michael J. Fox Foundation (3.9%). STEADY PD III serves as an important example of methods that can be used to increase clinical trial recruitment. This research highlights a continued need to improve site infrastructure and dedicate more resources to increased participation of minorities in clinical research.

Increasing Efficiency of Recruitment in Early Parkinson’s Disease Trials: A Case Study Examination of the STEADY-PD III Trial

PubMed Central

Berk, Sarah; Greco, Brittany L.; Biglan, Kevin; Kopil, Catherine M.; Holloway, Robert G.; Meunier, Claire; Simuni, Tanya

2017-01-01

Background: Challenges in clinical trial recruitment threaten the successful development of improved therapies. This is particularly true in Parkinson’s disease (PD) studies of disease modification where the population of interest is difficult to find and study design is more complex. Objective: This paper seeks to understand how STEADY PD III, a National Institute of Neurological Disorders and Stroke (NINDS) funded phase 3 trial evaluating the efficacy of isradipine as a disease modifying agent for PD, was able to recruit their full target population 6 months ahead of schedule. Methods: STEADY PD III aimed to enroll 336 individuals with early stage idiopathic PD within 18 months using 57 sites across the United States and Canada. The study included a 10% NIH minority recruitment goal. Eligible participants agreed to be followed for up to 36 months, complete 12 in-person visits and 4 telephone visits. A Recruitment Committee of key stakeholders was critical in the development of a comprehensive recruitment strategy involving: multi-modal outreach, protocol modifications and comprehensive site selection and activation. Efforts to increase site-specific minority recruitment strategies were encouraged through additional funding. Results: A total of 336 individuals, including 34 minorities, were enrolled within 12 months – 6 months ahead of the projected timeline. Quantitative analysis of recruitment activity questionnaires found that of the sites that completed them (n = 54), (20.4%) met goals, (24.1%) exceeded goals, and (55.6%) fell below projected goals. Referral sources completed at time of screening indicate top four study referral sources as: site personnel (53.8%); neurologists (24%); Fox Trial Finder (10.2%); and communications from The Michael J. Fox Foundation (3.9%). Conclusions: STEADY PD III serves as an important example of methods that can be used to increase clinical trial recruitment. This research highlights a continued need to improve site infrastructure and dedicate more resources to increased participation of minorities in clinical research. PMID:29103052

Preliminary Evaluation of Removing Used Nuclear Fuel from Shutdown Sites

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

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

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

Rural and urban park visits and park-based physical activity.

PubMed

Shores, Kindal A; West, Stephanie T

2010-01-01

A physical activity disparity exists between rural and urban residents. Community parks are resources for physical activity because they are publicly provided, available at a low cost, and accessible to most residents. We examine the use of and physical activity outcomes associated with rural and urban parks. Onsite observations were conducted using the System for Observing Play and Recreation in Communities (SOPARC) at four rural and four urban parks. Momentary sampling scans were conducted four times per day for seven days at each site. A total of 6,545 park visitors were observed. Both rural and urban park visitors were observed more often at larger parks with paved trails and attended most often on weekends. Rural park visits were more frequent than urban park visits but rural visits were less physically active. Although similarities were observed between rural and urban park visits, differences suggest that findings from park and physical activity studies in urban areas should not be considered representative of their rural counterparts. Given that the majority of existing park and physical activity research has been undertaken in urban settings, the need for complementary research in rural settings has been made evident through this presentation of baseline descriptive data.

The pollination biology of a pavement plain: pollinator visitation patterns.

PubMed

O'Brien, Mary H

1980-01-01

The pollination biology of the 20 plant species of a treeless, pavement plain in the San Bernardino Mountains of southern California was studied throughout one flowering season.Several patterns of pollinator activity recorded during the season underline the necessity for noting the activity of all insect pollinators whether specialized, non-specialized, regular, or occasional: 1) Occasional insect visitors were a feature of the visitation to nine of the twelve entomophilous plant species and were the sole pollinators for three of these twelve species. 2) The eight entomophilous plant species which had open, generalized flower morphologies received the heaviest pollinator visitation, while three of the four entomophilous species with specialized flower morphologies received little visitation. 3) Most regular flower visitors, whether bees, flies, or wasps, appeared to be similar with respect to number of plant species visited regularly, purity of pollen load, length of residence and localization of activity on the site. The question is raised as to whether such similarity of behavior as pollen vectors is a function of the low plant diversity or a feature commonly found when the pollen loads and behavior of different pollinator types are actually monitored.

Blue Ribbon Commission Tour of Hanford Site

ScienceCinema

Paul Saueressig

2017-12-09

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

42 CFR 3.110 - Assessment of PSO compliance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... reviews of, or site visits to, PSOs, to assess or verify PSO compliance with the requirements of this subpart and for these purposes will be allowed to inspect the physical or virtual sites maintained or...

10 CFR 60.4 - Communications and records.

Code of Federal Regulations, 2011 CFR

2011-01-01

... sent by mail addressed: ATTN: Document Control Desk: Director, Office of Nuclear Material Safety and... obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to...

10 CFR 30.6 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... may be submitted to the Commission as follows: (1) By mail addressed: ATTN: Document Control Desk... visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to MSHD.Resource...

10 CFR 110.4 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

.... Detailed guidance on making electronic submissions can be obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]gov; or by writing the Office...

10 CFR 110.4 - Communications.

Code of Federal Regulations, 2012 CFR

2012-01-01

.... Detailed guidance on making electronic submissions can be obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]gov; or by writing the Office...

JPRS Report: Proliferation Issues

DTIC Science & Technology

1993-03-08

Mo’allem Khani -ye, approximately 150 km north of Rafsanjani’s brother-in-law and among the leaders of the Tehran. This is a base-most of it underground...the manner national Atomic Energy Agency visited Iran, its mem- in which Saddam Husayn was defeated. bers asked to visit the site at Mo’allem Khani -ye

Defense.gov - Special Report: Travels with Lynn

Science.gov Websites

social media. Story Simulation Center Provides Taste of Combat MARINE CORPS BASE CAMP PENDELTON, Calif Force's battle simulation center at Marine Corps Base Camp Pendleton, Calif. Story 'Adaptable' U.S. Troops Visits Vandenberg Air Force Base and Los Angeles Lynn Visits Navy and Marine Bases About This Site DoD

"Response to Intervention" Sparks Interest, Questions

ERIC Educational Resources Information Center

Samuels, Christina A.

2008-01-01

As a demonstration site designated by Oregon as a prime example of "response to intervention" in action, the Tigard-Tualatin district has had to pare visiting groups down to no more than 25 people. During the last few visits, 50 people descended on the district just outside Portland at one time. As educators in Tigard-Tualatin and…

Standardization of Laboratory Methods for the PERCH Study

PubMed Central

Karron, Ruth A.; Morpeth, Susan C.; Bhat, Niranjan; Levine, Orin S.; Baggett, Henry C.; Brooks, W. Abdullah; Feikin, Daniel R.; Hammitt, Laura L.; Howie, Stephen R. C.; Knoll, Maria Deloria; Kotloff, Karen L.; Madhi, Shabir A.; Scott, J. Anthony G.; Thea, Donald M.; Adrian, Peter V.; Ahmed, Dilruba; Alam, Muntasir; Anderson, Trevor P.; Antonio, Martin; Baillie, Vicky L.; Dione, Michel; Endtz, Hubert P.; Gitahi, Caroline; Karani, Angela; Kwenda, Geoffrey; Maiga, Abdoul Aziz; McClellan, Jessica; Mitchell, Joanne L.; Morailane, Palesa; Mugo, Daisy; Mwaba, John; Mwansa, James; Mwarumba, Salim; Nyongesa, Sammy; Panchalingam, Sandra; Rahman, Mustafizur; Sawatwong, Pongpun; Tamboura, Boubou; Toure, Aliou; Whistler, Toni; O’Brien, Katherine L.; Murdoch, David R.

2017-01-01

Abstract The Pneumonia Etiology Research for Child Health study was conducted across 7 diverse research sites and relied on standardized clinical and laboratory methods for the accurate and meaningful interpretation of pneumonia etiology data. Blood, respiratory specimens, and urine were collected from children aged 1–59 months hospitalized with severe or very severe pneumonia and community controls of the same age without severe pneumonia and were tested with an extensive array of laboratory diagnostic tests. A standardized testing algorithm and standard operating procedures were applied across all study sites. Site laboratories received uniform training, equipment, and reagents for core testing methods. Standardization was further assured by routine teleconferences, in-person meetings, site monitoring visits, and internal and external quality assurance testing. Targeted confirmatory testing and testing by specialized assays were done at a central reference laboratory. PMID:28575358

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings

PubMed Central

Obure, Carol Dayo; Sweeney, Sedona; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Guinness, Lorna; Terris-Prestholt, Fern; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte E.; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

2015-01-01

Objective To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. Design A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. Methods Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider’s perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. Results The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. Conclusion For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements. PMID:25933414

The movement of a forager: strategies for the efficient use of resources

NASA Astrophysics Data System (ADS)

Kazimierski, Laila D.; Abramson, Guillermo; Kuperman, Marcelo N.

2016-10-01

We study a simple model of a foraging animal that modifies the substrate on which it moves. This substrate provides its only resource, and the forager manages it by taking a limited portion at each visited site. The resource recovers its value after the visit following a relaxation law. We study different scenarios to analyze the efficiency of the managing strategy, corresponding to control the bite size. We observe the non trivial emergence of a home range, that is visited in a periodic way. The duration of the corresponding cycles and the transient until it emerges is affected by the bite size. Our results show that the most efficient use of the resource, measured as the balance between gathering and traveled distance, corresponds to foragers that take larger portions but without exhausting the resource. We also analyze the use of space determining the number of attractors of the dynamics, and we observe that it depends on the bite size and the recovery time of the resource.

Use of the computer and Internet among Italian families: first national study.

PubMed

Bricolo, Francesco; Gentile, Douglas A; Smelser, Rachel L; Serpelloni, Giovanni

2007-12-01

Although home Internet access has continued to increase, little is known about actual usage patterns in homes. This nationally representative study of over 4,700 Italian households with children measured computer and Internet use of each family member across 3 months. Data on actual computer and Internet usage were collected by Nielsen//NetRatings service and provide national baseline information on several variables for several age groups separately, including children, adolescents, and adult men and women. National averages are shown for the average amount of time spent using computers and on the Web, the percentage of each age group online, and the types of Web sites viewed. Overall, about one-third of children ages 2 to 11, three-fourths of adolescents and adult women, and over four-fifths of adult men access the Internet each month. Children spend an average of 22 hours/month on the computer, with a jump to 87 hours/month for adolescents. Adult women spend less time (about 60 hours/month), and adult men spend more (over 100). The types of Web sites visited are reported, including the top five for each age group. In general, search engines and Web portals are the top sites visited, regardless of age group. These data provide a baseline for comparisons across time and cultures.

Spatial distribution of soil contaminated with Toxoplasma gondii oocysts in relation to the distribution and use of domestic cat defecation sites on dairy farms.

PubMed

Simon, J A; Kurdzielewicz, S; Jeanniot, E; Dupuis, E; Marnef, F; Aubert, D; Villena, I; Poulle, M-L

2017-05-01

Little information is available on the relationship between the spatial distribution of zoonotic parasites in soil and the pattern of hosts' faeces deposition at a local scale. In this study, the spatial distribution of soil contaminated by the parasite Toxoplasma gondii was investigated in relation to the distribution and use of the defecation sites of its definitive host, the domestic cat (Felis catus). The study was conducted on six dairy farms with a high number of cats (seven to 30 cats). During regular visits to the farms over a 10month period, the cat population and cat defecation sites (latrines and sites of scattered faeces) on each farm were systematically surveyed. During the last visit, 561 soil samples were collected from defecation sites and random points, and these samples were searched for T. gondii DNA using real-time quantitative PCR. Depending on the farm, T. gondii DNA was detected in 37.7-66.3% of the soil samples. The proportion of contaminated samples at a farm was positively correlated with the rate of new cat latrines replacing former cat latrines, suggesting that inconstancy in use of a latrine by cats affects the distribution of T. gondii in soil. On the farms, known cat defecation sites were significantly more often contaminated than random points, but 25-62.5% of the latter were also found to be contaminated. Lastly, the proportion of positive T. gondii samples in latrines was related to the proximity of the cats' main feeding and resting sites on the farms. This study demonstrates that T. gondii can be widely distributed in farm soil despite the heterogeneous distribution of cat faeces. This supports the hypothesis that farms are hotspot areas for the risk of T. gondii oocyst-induced infection in rural environments. Copyright © 2017 Australian Society for Parasitology. Published by Elsevier Ltd. All rights reserved.

Report: Observed Conditions at Five Deleted Superfund Sites

EPA Pesticide Factsheets

Report #11-P-0433, August 3, 2011. Conditions at two of the five sites we visited in EPA Region 3, which had been remediated and deleted from the National Priorities List, may warrant additional attention from EPA.

10 CFR 15.3 - Communications.

Code of Federal Regulations, 2012 CFR

2012-01-01

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

10 CFR 15.3 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

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

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.

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

PubMed

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

2014-01-01

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

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…

A Feasibility Study to Assess Alternative Energy Program Development Potential at the Community College Level, October 1, 1983-June 30, 1984. Final Report.

ERIC Educational Resources Information Center

Blair, Brittain A.

In 1983-84, a feasibility study was conducted to determine the viability of establishing a comprehensive alternative energy technology program at Southeastern Illinois College (SIC). The study involved an examination of a number of exemplary associate degree programs in alternative energy, through on-site visits and telephone surveys; a survey of…

Feasibility of Patient Reporting of Symptomatic Adverse Events via the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a Chemoradiotherapy Cooperative Group Multicenter Clinical Trial.

PubMed

Basch, Ethan; Pugh, Stephanie L; Dueck, Amylou C; Mitchell, Sandra A; Berk, Lawrence; Fogh, Shannon; Rogak, Lauren J; Gatewood, Marcha; Reeve, Bryce B; Mendoza, Tito R; O'Mara, Ann M; Denicoff, Andrea M; Minasian, Lori M; Bennett, Antonia V; Setser, Ann; Schrag, Deborah; Roof, Kevin; Moore, Joan K; Gergel, Thomas; Stephans, Kevin; Rimner, Andreas; DeNittis, Albert; Bruner, Deborah Watkins

2017-06-01

To assess the feasibility of measuring symptomatic adverse events (AEs) in a multicenter clinical trial using the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Patients enrolled in NRG Oncology's RTOG 1012 (Prophylactic Manuka Honey for Reduction of Chemoradiation Induced Esophagitis-Related Pain during Treatment of Lung Cancer) were asked to self-report 53 PRO-CTCAE items representing 30 symptomatic AEs at 6 time points (baseline; weekly ×4 during treatment; 12 weeks after treatment). Reporting was conducted via wireless tablet computers in clinic waiting areas. Compliance was defined as the proportion of visits when an expected PRO-CTCAE assessment was completed. Among 226 study sites participating in RTOG 1012, 100% completed 35-minute PRO-CTCAE training for clinical research associates (CRAs); 80 sites enrolled patients, of which 34 (43%) required tablet computers to be provided. All 152 patients in RTOG 1012 agreed to self-report using the PRO-CTCAE (median age 66 years; 47% female; 84% white). Median time for CRAs to learn the system was 60 minutes (range, 30-240 minutes), and median time for CRAs to teach a patient to self-report was 10 minutes (range, 2-60 minutes). Compliance was high, particularly during active treatment, when patients self-reported at 86% of expected time points, although compliance was lower after treatment (72%). Common reasons for noncompliance were institutional errors, such as forgetting to provide computers to participants; patients missing clinic visits; Internet connectivity; and patients feeling "too sick." Most patients enrolled in a multicenter chemoradiotherapy trial were willing and able to self-report symptomatic AEs at visits using tablet computers. Minimal effort was required by local site staff to support this system. The observed causes of missing data may be obviated by allowing patients to self-report electronically between visits, and by using central compliance monitoring. These approaches are being incorporated into ongoing studies. Copyright © 2017 Elsevier Inc. All rights reserved.

The hummingbird community and their floral resources in an urban forest remnant in Brazil.

PubMed

Rodrigues, L C; Araujo, A C

2011-08-01

The temporal and spatial resource use among hummingbirds was studied over 13 months in an urban forest remnant (Prosa State Park: PSP) in Campo Grande, Mato Grosso do Sul, Brazil. Hummingbird visitation was recorded at three ornithophilous and eleven non-ornithophilous species. Flower density was roughly constant during the study period, with the density of non-ornithophilous flowers being higher than that of ornithophilous ones. Mean values of nectar volume and concentration were similar between ornithophilous and non-ornithophilous species. Eight hummingbird species were observed at PSP: Amazilia fimbriata, Anthracothorax nigricollis, Chlorostilbon lucidus, Eupetomena macroura, Hylocharis chrysura, Florisuga fusca, Thalurania furcata and an unidentified species. Hummingbird visit frequencies to ornithophilous and non-ornithophilous flowers were similar. However, some non-ornithophilous species received a higher number of visits, which seems to be related to their large number of open flowers per plant per day. The number of feedings bouts of hummingbirds increased with the total number of flowers observed per focal plant. All recorded species of hummingbirds visited non-ornithophilous flowers, predominantly melittophilous and generalised entomophilous flowers. Hummingbird species recorded at PSP may be viewed as generalists, visiting a large number of non-ornithophilous species. Despite being an urban forest, PSP is relatively rich in hummingbird species, suggesting that it provides important shelter and foraging sites for hummingbirds in such an environment.

Effectiveness of Evidence-Based Asthma Interventions.

PubMed

Kennedy, Suzanne; Bailey, Ryan; Jaffee, Katy; Markus, Anne; Gerstein, Maya; Stevens, David M; Lesch, Julie Kennedy; Malveaux, Floyd J; Mitchell, Herman

2017-06-01

Researchers often struggle with the gap between efficacy and effectiveness in clinical research. To bridge this gap, the Community Healthcare for Asthma Management and Prevention of Symptoms (CHAMPS) study adapted an efficacious, randomized controlled trial that resulted in evidence-based asthma interventions in community health centers. Children (aged 5-12 years; N = 590) with moderate to severe asthma were enrolled from 3 intervention and 3 geographically/capacity-matched control sites in high-risk, low-income communities located in Arizona, Michigan, and Puerto Rico. The asthma intervention was tailored to the participant's allergen sensitivity and exposure, and it comprised 4 visits over the course of 1 year. Study visits were documented and monitored prospectively via electronic data capture. Asthma symptoms and health care utilization were evaluated at baseline, and at 6 and 12 months. A total of 314 intervention children and 276 control children were enrolled in the study. Allergen sensitivity testing (96%) and home environmental assessments (89%) were performed on the majority of intervention children. Overall study activity completion (eg, intervention visits, clinical assessments) was 70%. Overall and individual site participant symptom days in the previous 4 weeks were significantly reduced compared with control findings (control, change of -2.28; intervention, change of -3.27; difference, -0.99; P < .001), and this result was consistent with changes found in the rigorous evidence-based interventions. Evidence-based interventions can be successfully adapted into primary care settings that serve impoverished, high-risk populations, reducing the morbidity of asthma in these high-need populations. Copyright © 2017 by the American Academy of Pediatrics.

Remote camera-trap methods and analyses reveal impacts of rangeland management on Namibian carnivore communities

USGS Publications Warehouse

Kauffman, M.J.; Sanjayan, M.; Lowenstein, J.; Nelson, A.; Jeo, R.M.; Crooks, K.R.

2007-01-01

Assessing the abundance and distribution of mammalian carnivores is vital for understanding their ecology and providing for their long-term conservation. Because of the difficulty of trapping and handling carnivores many studies have relied on abundance indices that may not accurately reflect real abundance and distribution patterns. We developed statistical analyses that detect spatial correlation in visitation data from combined scent station and camera-trap surveys, and we illustrate how to use such data to make inferences about changes in carnivore assemblages. As a case study we compared the carnivore communities of adjacent communal and freehold rangelands in central Namibia. We used an index of overdispersion to test for repeat visits to individual camera-trap scent stations and a bootstrap simulation to test for correlations in visits to camera neighbourhoods. After distilling our presence-absence data to the most defensible spatial scale, we assessed overall carnivore visitation using logistic regression. Our analyses confirmed the expected pattern of a depauparate fauna on the communal rangelands compared to the freehold rangelands. Additionally, the species that were not detected on communal sites were the larger-bodied carnivores. By modelling these rare visits as a Poisson process we illustrate a method of inferring whether or not such patterns are because of local extinction of species or are simply a result of low sample effort. Our Namibian case study indicates that these field methods and analyses can detect meaningful differences in the carnivore communities brought about by anthropogenic influences. ?? 2007 FFI.

Status of surveillance and routine immunization performances in Amhara Region, Ethiopia: findings from in-depth peer review.

PubMed

Lakew, Gebre Asmamaw; Wassie, Eshetu; Ademe, Ayesheshem; Fenta, Ayalneh; Wube, Solomon; Werede, Mihret; Kidane, Achenef; Mekonnen, Leulseged; Hiwot, Teklehaimanot Gebre; Gallagher, Kathleen

2017-01-01

Trend analyses of non-polio AFP and stool adequacy rates in Amhara Region showed optimal performance over the years. However, sub regional gaps continue to persist in certain zones where the reasons for low performance were not well documented. The objective of this study was to assess the performance of the disease surveillance and immunization system in Amhara Region, Ethiopia with emphasis on low performing woredas and zones. A descriptive cross-sectional study was conducted from July 2-10, 2015 to assess the structure, core and support surveillance functions in five zones and two town administrations that were purposively sampled based on differing performances, geographic location, and history of vaccine preventable disease outbreaks among others. Of the 82 sites reviewed, 71 (87%) have a designated surveillance focal person. Less than half 36(44%) of these focal persons have written terms of reference. Twenty-six (93%) of the health offices had a written surveillance work plan for the fiscal year. Only 17 (81%) of woreda health offices and town administrations had prioritized active surveillance sites into high, medium and low during the last 12 months. Only 4(17%) had independent active case search visits to these sites as per the priority. Seventy-eight (95%) and seventy-seven (94%) sites have a designated immunization focal person and updated EPI performance monitoring charts, respectively. There had been vaccine stock out in the 3 months before assessment in 28 (34%) of the sites. Though there is an existence of well-organized surveillance network with adoption of the integrated disease surveillance and response, gaps exist in following the standard guidelines and operation procedures. Improvements needed in reporting site priority setting and regular visiting for active case search, outbreak investigation and management, vaccine supply and overall documentations.

The association between fine particulate air pollution and hospital emergency room visits for cardiovascular diseases in Beijing, China.

PubMed

Guo, Yuming; Jia, Yuping; Pan, Xiaochuan; Liu, Liqun; Wichmann, H-Erich

2009-08-15

Because epidemiological studies have yielded different results, the association between exposure to fine particulate matter less than 2.5 microm in aerodynamic diameter (PM(2.5)) and acute events of cardiovascular diseases (CVD) is unknown. Additionally, no research has been conducted to explore the association between PM(2.5) and hospital emergency room (ER) visits of cardiovascular diseases in Beijing, China. To explore the association between PM(2.5) and the hospital ER visits in Beijing, China for CVD {(International Classification of Diseases, 10th vision (ICD-10): I00-I99)}. We collected data for daily hospital ER visits for CVD from the Peking University Third Hospital, daily ambient PM(2.5) data from a fixed monitor site at Peking University, and data on the daily level of gaseous air pollutants {sulfur dioxide (SO(2)) and nitrogen dioxide (NO(2))} from the Beijing Municipal Environmental Monitoring Center between June 1, 2004 and December 31, 2006. A time-stratified case-crossover design was used to evaluate associations between CVD health outcomes and ambient air pollutants. 8377 hospital ER visits of CVD were collected in our study. After adjusting the temperature and the relative humidity, the associations for 10 microg/m(3) increases in levels of PM(2.5), SO(2), or NO(2) and hospital ER visits for cardiovascular diseases were statistically significant with odds ratios (ORs) of 1.005{95% confidence interval (CI): 1.001-1.009}, 1.014(95% CI: 1.004-1.024), and 1.016(95% CI: 1.003-1.029), respectively. These findings suggest that elevated levels of ambient air pollutants are associated with the increase in hospital ER visits for CVD in Beijing, China.

Changing knowledge and beliefs through an oral health pregnancy message.

PubMed

Bates, S Brady; Riedy, Christine A

2012-01-01

Pregnancy can be a critical and important period in which to intervene to improve oral health in both the mother and her child. This study examined an online approach for promoting awareness of oral health messages targeted at pregnant women, and whether this type of health messaging impacts oral health knowledge and beliefs. The study was conducted in three parts: production and pilot testing of a brief commercial, Web site/commercial launch and testing, and dissemination and monitoring of the commercial on a video-sharing site. The brief commercial and pre- and postsurveys were produced and pilot tested among a convenience sample of pregnant women (n = 13). The revised commercial and surveys were launched on a newly created Web site and monitored for activity. After 2 months, the commercial was uploaded to a popular video-sharing Web site. Fifty-five individuals completed both the pre- and postsurveys after the Web site was launched. No one responded 100 percent correctly on the presurvey; 77.4 percent responded correctly about dental visits during pregnancy, 66.0 percent about cavity prevention, and 50.9 percent about transmission of bacteria by saliva. Most respondents recalled the correct information on the posttest; 100 percent or close to 100 percent accurately responded about visiting the dentist during pregnancy and preventing cavities, while 79.2 percent responded correctly to the transmission question. Social media can effectively provide dental health messages during pregnancy. This approach can play an important role in increasing awareness and improving oral health of both mother and child. © 2011 American Association of Public Health Dentistry.

Board of Scientific Counselors' Review of the National Center for Environmental Assessment: NCEA "SELF-Study" Report to the BOSC Subcommittee for NCEA

EPA Science Inventory

NCEA Self-Study Report to the BOSC Subcommittee for NCEA:

On October 10 and 11, 2001, the National Center for Environmental Assessment (NCEA) hosted at its Washington, DC offices a review and site visit by the Office of Research and Development's (ORD) Board ...

Adult Literacy: Skills for the American Work Force. Research and Development Series No. 265B.

ERIC Educational Resources Information Center

Hull, William L.; Sechler, Judith A.

A study examined the nature and extent of adult literacy needs in the American labor force. Data for the study were collected from a review of the literature, site visits to nine industry-based training programs, and consultation with a technical panel of experts. Input from company managers, instructors, and trainers familiar with the…

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

ERIC Educational Resources Information Center

Bailin, Michael A.

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

Endoscopic vs. tactile evaluation of subgingival calculus.

PubMed

Osborn, Joy B; Lenton, Patricia A; Lunos, Scott A; Blue, Christine M

2014-08-01

Endoscopic technology has been developed to facilitate imagery for use during diagnostic and therapeutic phases of periodontal care. The purpose of this study was to compare the level of subgingival calculus detection using a periodontal endoscope with that of conventional tactile explorer in periodontitis subjects. A convenience sample of 26 subjects with moderate periodontitis in at least 2 quadrants was recruited from the University of Minnesota School of Dentistry to undergo quadrant scaling and root planing. One quadrant from each subject was randomized for tactile calculus detection alone and the other quadrant for tactile detection plus the Perioscope ™ (Perioscopy Inc., Oakland, Cali). A calculus index on a 0 to 3 score was performed at baseline and at 2 post-scaling and root planing visits. Sites where calculus was detected at visit 1 were retreated. T-tests were used to determine within-subject differences between Perioscope™ and tactile measures, and changes in measures between visits. Significantly more calculus was detected using the Perioscope™ vs. tactile explorer for all 3 subject visits (p<0.005). Mean changes (reduction) in calculus detection from baseline to visit 1 were statistically significant for both the Perioscope™ and tactile quadrants (p<0.0001). However, further reductions in calculus detection from visit 1 to visit 2 was only significant for the Perioscope™ quadrant (p<0.025), indicating that this methodology was able to more precisely detect calculus at this visit. It was concluded that the addition of a visual component to calculus detection via the Perioscope™ was most helpful in the re-evaluation phase of periodontal therapy. Copyright © 2014 The American Dental Hygienists’ Association.

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

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

PubMed Central

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

2010-01-01

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

User Perceptions of a Dementia Risk Reduction Website and Its Promotion of Behavior Change

PubMed Central

2013-01-01

Background Several modifiable health and lifestyle factors are consistently associated with dementia risk and it is estimated that significantly fewer people would develop dementia if the incidence of risk factors could be reduced. Despite this, Australians’ awareness of the health and lifestyle factors associated with dementia risk is low. Within a national community education campaign, Alzheimer’s Australia developed a dementia risk reduction website providing information about modifiable risk or protective factors for dementia. Objective This study aimed to assess the usefulness of the website content in improving knowledge and enabling adoption of recommended strategies, and to examine what additional resources consumers need. Methods Visitors to the website over a 3 month period were invited to complete an online survey, which asked them to rate their knowledge of dementia risk reduction before and after visiting the site, how important monitoring their health related behavior was to them before and after visiting the site, their current behavior related to health and lifestyle factors associated with dementia risk, their intentions to change behavior, and the usefulness of potential additional resources to help them do so. Results For this study, 123 Australian adults responded to the survey. 44.7% (55/122) were aged over 60 and 82.1% (98/119) were female. Respondents’ ratings and comments indicated they generally found the content interesting, informative, and helpful to them. Respondents’ ratings of their knowledge about the links between health and lifestyle factors and dementia risk significantly increased after visiting the website (P<.001). Their ratings of how important monitoring what they do in relation to their health and lifestyle factors were also significantly increased after visiting the website (P<.001). Average ratings for how well respondents felt they were doing at the time in relation to specific risk or protective factors were generally high, suggesting many website visitors already had high levels of health motivation and healthy lifestyle behaviors. 55.6% (45/81) said that after visiting the website their intention to make lifestyle changes was strong. Only 27.1% (22/81) said their intention to visit their doctor to discuss dementia risk reduction was strong. Potential additional resources that would help people assess and address their personal dementia risk factors were rated as more helpful than general information resources. Conclusions A dementia risk reduction website providing information about the current evidence and practical strategies was of interest and was useful to the Australian community. Benefits for visitors included increased knowledge and increased motivation to address relevant behaviors. Many visitors to the site were already health conscious, indicating that more needs to be done to get dementia risk reduction messages to the wider community. More interactive and personalized resources in future interventions may offer additional benefits to individuals. PMID:23608480

Use of a web 2.0 portal to improve education and communication in young patients with families: randomized controlled trial.

PubMed

Hanberger, Lena; Ludvigsson, Johnny; Nordfeldt, Sam

2013-08-23

Diabetes requires extensive self-care and comprehensive knowledge, making patient education central to diabetes self-management. Web 2.0 systems have great potential to enhance health information and open new ways for patients and practitioners to communicate. To develop a Web portal designed to facilitate self-management, including diabetes-related information and social networking functions, and to study its use and effects in pediatric patients with diabetes. A Web 2.0 portal was developed in collaboration with patients, parents, and practitioners. It offered communication with local practitioners, interaction with peers, and access to relevant information and services. Children and adolescents with diabetes in a geographic population of two pediatric clinics in Sweden were randomized to a group receiving passwords for access to the portal or a control group with no access (n=230) for 1 year. All subjects had access during a second study year. Users' activity was logged by site and page visits. Health-related quality of life (HRQOL), empowerment (DES), and quality of information (QPP) questionnaires were given at baseline and after 1 and 2 study years. Clinical data came from the Swedish pediatric diabetes quality registry SWEDIABKIDS. There was a continuous flow of site visits, decreasing in summer and Christmas periods. In 119/233 families (51%), someone visited the portal the first study year and 169/484 (35%) the second study year. The outcome variables did not differ between intervention and control group. No adverse treatment or self-care effects were identified. A higher proportion of mothers compared to fathers visited once or more the first year (P<.001) and the second year (P<.001). The patients who had someone in the family visiting the portal 5 times or more, had shorter diabetes duration (P=.006), were younger (P=.008), had lower HbA1c after 1 year of access (P=.010), and were more often girls (P<.001). Peer interaction seems to be a valued aspect. The Web 2.0 portal may be useful as a complement to traditional care for this target group. Widespread use of a portal would need integration in routine care and promotion by diabetes team members. International Standard Randomized Controlled Trial Number (ISRCTN):92107365; http://www.controlled-trials.com/ISRCTN92107365/ (Archived by WebCite at http://webcitation.org/6IkiIvtSb).

Exploring the Use of a Facebook Page in Anatomy Education

ERIC Educational Resources Information Center

Jaffar, Akram Abood

2014-01-01

Facebook is the most popular social media site visited by university students on a daily basis. Consequently, Facebook is the logical place to start with for integrating social media technologies into education. This study explores how a faculty-administered Facebook Page can be used to supplement anatomy education beyond the traditional…

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…

Liberal Arts Colleges: Thriving, Surviving, or Endangered?

ERIC Educational Resources Information Center

Breneman, David W.

This book examines the recent and changing financial circumstances of the independent liberal arts college in America through financial and economic analysis and discussion of educational purpose and mission. The work is based on a study of 212 colleges including site visits to 12. Chapter 1 is an introduction. Chapter 2 contains an overview of…

Transportation of Wheelchair Seated Students in School Buses: A Review of State Policy

ERIC Educational Resources Information Center

Moore, Britta; Fuhrman, Susan; Karg, Patricia

2010-01-01

This study quantitatively reviews publicly available state policies as they relate to the transportation of wheelchair-seated students in school buses. Inclusion of best practices in specially equipped school bus and driver training policies was assessed. Key points of interest within state policies were identified based on site visits, common…

Identifying Values: The Front-End of Systemic School Restructuring.

ERIC Educational Resources Information Center

Lee, In-Sook

The comprehensive categories of values, and the values in each category, to be articulated and consented to by stakeholders in school restructuring are explored through a qualitative case-study approach. A public elementary school that had approximately 530 students and that was undergoing restructuring was selected. Site visits, document reviews,…

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…

Entry Strategies of First-Time High School Principals.

ERIC Educational Resources Information Center

Hall, Gene E.; Mani, M. N. G.

To determine the first things that a new principal does during the first few months on the job, an intensive case study was conducted of 12 first-time high school principals in Florida, Virginia, Missouri, and Colorado. Each beginning principal was assigned a research team member who conducted on-site visits, reviewed documentation regarding the…

On the Merits of "Unusual Field Trips."

ERIC Educational Resources Information Center

Howarth, Dean E.

1999-01-01

Describes the organization and completion of a scientific field trip for a group of high school physics students that was organized primarily around a study of the Manhattan Project. The group visited the Trinity site, Los Alamos, several museums, and the National Radio Astronomy Observatory Very Large Array. Contact information for the various…

What's a walk on the wildside worth?

Treesearch

Elwood L. Shafer

1995-01-01

Quantitative measures of the economic nonconsumptive values of observing wildlife in forest environments are not widely available. Six case studies of fish and wildlife amenity values are briefly described. The annual total consumers' surplus value of all six activities was twice the total out-of-pocket expenditures spent to visit the six sites involved. The...

Hair removal for Fitzpatrick skin types V and VI using light and heat energy technology.

PubMed

Sadick, Neil S; Krespi, Yoseph

2006-09-01

To determine the safety and efficacy of a light and heat energy (LHE)-based system (SkinStaion system; Radiancy Inc, Orangeburg, NY, USA) for hair removal in subjects with skin types V and VI. Thirty-one subjects with Fitzpatrick skin types V and VI were consented for treatment with the system. Twenty-six subjects completed the 12-week follow-up. Safety was evaluated at each visit and efficacy was evaluated at both follow-up visits. An average hair clearance of 41.7% from 57 treatment sites was reported at the 6-week follow-up visit and a 35.5% average hair clearance was reported at the 12-week follow-up. Edema was only reported in 2 cases (7.7%) of the study population. Eleven cases of erythema were reported following treatment. Treatment with the modified LHE system was safe and effective for hair removal in patients with skin types V and VI.

What Works for Women in Undergraduate Physics and What We Can Learn from Women's Colleges

NASA Astrophysics Data System (ADS)

Whitten, Barbara L.; Dorato, Shannon R.; Duncombe, Margaret L.; Allen, Patricia E.; Blaha, Cynthia A.; Butler, Heather Z.; Shaw, Kimberly A.; Taylor, Beverley A. P.; Williams, Barbara A.

We are studying the recruitment and retention of women in undergraduate physics by conducting site visits to physics departments. In this second phase of the project, we visited six physics departments in women's colleges. We compared these departments to each other and to the nine departments in coeducational schools that we visited in phase 1 of the project (Whitten, Foster, & Duncombe, 2003a; Whitten et al., 2003b; Whitten et al., 2004). We learned that women's colleges, much more than coed schools, try to recruit students into the physics major. This has led us to criticize the "leaky pipeline" metaphor often used to describe women in physics and to call attention to women dropping in to the physics pipeline. We discuss our results for students and pedagogy and for faculty and institutions, and we offer some advice on how to make a physics department more female friendly.

[Identification of meeting places of sexual partners in 2 cities of the Southern Mexican borders, using the PLACE method].

PubMed

Negroni-Belén, Mirka; Vargas-Guadarrama, Galileo; Rueda-Neria, Celina Magally; Bassett-Hileman, Sarah; Weir, Sharon; Bronfman, Mario

2003-01-01

To identify the meeting sites of new sexual partners in two Southern border cities in Mexico. A descriptive epidemiologic study was carried out in May 2001, by surveying key informants in two border cities. Each reported site was visited to interview a resident subject. Subjects socializing in a subsample of sites were also interviewed. The key informants of the community reported 134 meeting sites in Chetumal and 111 in Ciudad Hidalgo. Both sites had scarce HIV/AIDS prevention activities. Characteristics were obtained for 89 sites in Chetumal and 42 in Ciudad Hidalgo. Almost 21% of interviewees reportedly met a new sexual partner in these sites in the past four weeks. Preventive actions are needed in meeting sites of new sexual partners. This method may provide information to plan for future interventions. The English version of this paper is available too at:http://www.insp.mx/salud/index.html.

76 FR 78264 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-16

... HHAs and Supp. Regs. in 42 CFR 48.55, 484.205, 484.245, 484.250; Use: This data set is currently... program. Since 1999, the Medicare CoPs have mandated that HHAs use the OASIS data set when evaluating... visits; the data collected during site visits facilitates the verification of the accuracy and...

Estimating Recreation Visitation Response to Forest Management Alternatives in the Columbia River Basin

Treesearch

Donald B.K. English; Amy Horne

1996-01-01

To evaluate how forest management alternatives affect recreation visitation, managers need to know both the changes in demand for the sites being altered and the general changes in regional recreation trip production. This paper shows one way to obtain that information. Trip-generation models developed for the United States Forest Service's national assessments of...

10 CFR 4.5 - Communications and reports.

Code of Federal Regulations, 2012 CFR

2012-01-01

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

10 CFR 4.5 - Communications and reports.

Code of Federal Regulations, 2011 CFR

2011-01-01

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

Protecting the Lunar Heritage Sites from the Effects of Visiting Spacecraft

NASA Technical Reports Server (NTRS)

Metzger, Philip; Lane, John E.

2012-01-01

The Problem: Rocket exhaust blows soil and rocks over vast distances at velocities upwards of 1 to 3 km/s, and this will be highly abrasive and damaging if it impacts the valuable lunar heritage sites.

Rochester scientist discovers new comet with Dark Energy Camera (DECam) at

Science.gov Websites

Sites Group MASS-DIMM New Projects NOAO Future Instrumentation DECam SAM LSST MONSOON What is MONSOON AURA Sites Group Talks and Meetings Upcoming Colloquia Sky Conditions CTIO Site Conditions TASCA colleagues believe. David Cameron, a visiting scientist in Eric Mamajek's research group in the Department of

Testing the Effectiveness of Interactive Multimedia for Library-User Education

ERIC Educational Resources Information Center

Markey, Karen; Armstrong, Annie; De Groote, Sandy; Fosmire, Michael; Fuderer, Laura; Garrett, Kelly; Georgas, Helen; Sharp, Linda; Smith, Cheri; Spaly, Michael; Warner, Joni E.

2005-01-01

A test of the effectiveness of interactive multimedia Web sites demonstrates that library users' topic knowledge was significantly greater after visiting the sites than before. Library users want more such sites about library services, their majors, and campus life generally. Librarians describe the roles they want to play on multimedia production…

Study protocol to assess the effectiveness and safety of a flexible family visitation model for delirium prevention in adult intensive care units: a cluster-randomised, crossover trial (The ICU Visits Study).

PubMed

Rosa, Regis Goulart; Falavigna, Maicon; Robinson, Caroline Cabral; da Silva, Daiana Barbosa; Kochhann, Renata; de Moura, Rafaela Moraes; Santos, Mariana Martins Siqueira; Sganzerla, Daniel; Giordani, Natalia Elis; Eugênio, Cláudia; Ribeiro, Tarissa; Cavalcanti, Alexandre Biasi; Bozza, Fernando; Azevedo, Luciano Cesar Pontes; Machado, Flávia Ribeiro; Salluh, Jorge Ibrain Figueira; Pellegrini, José Augusto Santos; Moraes, Rafael Barberena; Hochegger, Taís; Amaral, Alexandre; Teles, José Mario Meira; da Luz, Lucas Gobetti; Barbosa, Mirceli Goulart; Birriel, Daniella Cunha; Ferraz, Iris de Lima; Nobre, Vandack; Valentim, Helen Martins; Corrêa E Castro, Livia; Duarte, Péricles Almeida Delfino; Tregnago, Rogério; Barilli, Sofia Louise Santin; Brandão, Nilton; Giannini, Alberto; Teixeira, Cassiano

2018-04-13

Flexible intensive care unit (ICU) visiting hours have been proposed as a means to improve patient-centred and family-centred care. However, randomised trials evaluating the effects of flexible family visitation models (FFVMs) are scarce. This study aims to compare the effectiveness and safety of an FFVM versus a restrictive family visitation model (RFVM) on delirium prevention among ICU patients, as well as to analyse its potential effects on family members and ICU professionals. A cluster-randomised crossover trial involving adult ICU patients, family members and ICU professionals will be conducted. Forty medical-surgical Brazilian ICUs with RFVMs (<4.5 hours/day) will be randomly assigned to either an RFVM (visits according to local policies) or an FFVM (visitation during 12 consecutive hours per day) group at a 1:1 ratio. After enrolment and follow-up of 25 patients, each ICU will be switched over to the other visitation model, until 25 more patients per site are enrolled and followed. The primary outcome will be the cumulative incidence of delirium among ICU patients, measured twice a day using the Confusion Assessment Method for the ICU. Secondary outcome measures will include daily hazard of delirium, ventilator-free days, any ICU-acquired infections, ICU length of stay and hospital mortality among the patients; symptoms of anxiety and depression and satisfaction among the family members; and prevalence of burnout symptoms among the ICU professionals. Tertiary outcomes will include need for antipsychotic agents and/or mechanical restraints, coma-free days, unplanned loss of invasive devices and ICU-acquired pneumonia, urinary tract infection or bloodstream infection among the patients; self-perception of involvement in patient care among the family members; and satisfaction among the ICU professionals. The study protocol has been approved by the research ethics committee of all participant institutions. We aim to disseminate the findings through conferences and peer-reviewed journals. NCT02932358. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

PubMed

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

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

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

PubMed Central

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

2017-01-01

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

Compliance with focused antenatal care services: do health workers in rural Burkina Faso, Uganda and Tanzania perform all ANC procedures?

PubMed

Conrad, Paul; Schmid, Gerhrd; Tientrebeogo, Justin; Moses, Arinaitwe; Kirenga, Silvia; Neuhann, Florian; Müller, Olaf; Sarker, Malabika

2012-03-01

To assess health workers' compliance with the procedures set in the focused antenatal care (ANC) guidelines in rural Uganda, Tanzania and Burkina Faso; to compare the compliance within and among the three study sites; and to appraise the logistic and supply of the respective health facilities (HF). The cross-sectional study was conducted in the rural HF in three African countries. This descriptive observational study took place in HF in Nouna, Burkina Faso (5), Iganga, Uganda (6) and Rufiji, Tanzania (7). In total, 788 ANC sessions and service provisions were observed, the duration of each ANC service provision was calculated, and the infrastructures of the respective HF were assessed. Health workers in all HF performed most of the procedures but also omitted certain practices stipulated in the focused ANC guidelines. There was a substantial variation in provision of ANC services among HF within and among the country sites. The findings also revealed that the duration of first visits was <15 min and health workers spent even less time in subsequent visits in all three sites. Reagents for laboratory tests and drugs as outlined in the focus ANC guidelines were often out of stock in most facilities. Health workers in all three country sites failed to perform all procedures stipulated in the focused ANC guideline; this could not be always explained by the lack of supplies. It is crucial to point out the necessity of the core procedures of ANC repeatedly. © 2011 Blackwell Publishing Ltd.

A real-world, multi-site, observational study of infusion time and treatment satisfaction with rheumatoid arthritis patients treated with intravenous golimumab or infliximab.

PubMed

Daniel, Shoshana R; McDermott, John D; Le, Cathy; Pierce, Christine A; Ziskind, Michael A; Ellis, Lorie A

2018-05-25

To assess real-world infusion times for golimumab (GLM-IV) and infliximab (IFX) for rheumatoid arthritis (RA) patients and factors associated with treatment satisfaction. An observational study assessed infusion time including: clinic visit duration, RA medication preparation and infusion time, and infusion process time. Satisfaction was assessed by a modified Treatment Satisfaction Questionnaire for Medication (patient) and study-specific questionnaires (patient and clinic personnel). Comparative statistical testing for patient data utilized analysis of variance for continuous measures, and Fisher's exact or Chi-square test for categorical measures. Multivariate analysis was performed for the primary time endpoints and patient satisfaction. One hundred and fifty patients were enrolled from six US sites (72 GLM-IV, 78 IFX). The majority of patients were female (80.0%) and Caucasian (88.7%). GLM-IV required fewer vials per infusion (3.7) compared to IFX (4.9; p = .0001). Clinic visit duration (minutes) was shorter for GLM-IV (65.1) compared to IFX (153.1; p < .0001), as was total infusion time for RA medication (32.8 GLM-IV, 119.5 IFX; p < .0001) and infusion process times (45.8 GLM-IV, 134.1 IFX; p < .0001). Patients treated with GLM-IV reported higher satisfaction ratings with infusion time (p < .0001) and total visit time (p = .0003). Clinic personnel reported higher satisfaction with GLM-IV than IFX specific to medication preparation time, ease of mixing RA medication, frequency of patients requiring pre-medication, and infusion time. Findings may not be representative of care delivery for all RA infusion practices or RA patients. Shorter overall clinic visit duration, infusion process, and RA medication infusion times were observed for GLM-IV compared to IFX. A shorter duration in infusion time was associated with higher patient and clinic personnel satisfaction ratings.

KSC-04pd0851

NASA Image and Video Library

2004-04-13

KENNEDY SPACE CENTER, FLA. - Center Director Jim Kennedy (center) and Principal Aaron Fernander (right) visit a classroom in Ralph Bunche Middle School, a NASA Explorer School, in Atlanta, Ga. At left is Ralph Thomas, assistant administrator for Small and Disadvantaged Business Utilization at NASA. Kennedy is visiting NES sites to share America’s new vision for space exploration with the next generation of explorers. He was accompanied by astronaut Rick Linnehan on the visit. The purpose of the school visit is to talk with students about our destiny as explorers, NASA’s stepping stone approach to exploring Earth, the Moon, Mars and beyond, how space impacts our lives, and how people and machines rely on each other in space.

Solar pond power plant feasibility study for Davis, California

NASA Technical Reports Server (NTRS)

Wu, Y. C.; Singer, M. J.; Marsh, H. E.; Harris, J.; Walton, A. L.

1982-01-01

The feasibility of constructing a solar pond power plant at Davis, California was studied. Site visits, weather data compilation, soil and water analyses, conceptual system design and analyses, a material and equipment market survey, conceptual site layout, and a preliminary cost estimate were studied. It was concluded that a solar pond power plant is technically feasible, but economically unattractive. The relatively small scale of the proposed plant and the high cost of importing salt resulted in a disproportionately high capital investment with respect to the annual energy production capacity of the plant. Cycle optimization and increased plant size would increase the economical attractiveness of the proposed concept.

Using social networking sites (namely Facebook) in health visiting practice--an account of five years experience.

PubMed

Dion, Xena

2015-02-01

With new developments in electronic and social networking communication methods the way health visitors communicate with clients is rapidly changing. With good governance these technologies can be utilised to enhance the health visiting service and can be an effective way of accessing hard-to-reach families, saving time and resources. This paper presents five years' experience in the use of Facebook between the health visiting team and clients and explains the benefits and potential it offers to health visitors and other community practitioners.

Survival of Implants in Immediate Extraction Sockets of Anterior Teeth: Early Clinical Results

PubMed Central

Sabir, Mohammad

2015-01-01

Background The aims and objectives of this study were placement of implants in freshly extracted sockets of anterior teeth and to evaluate the implant stability, peri-implant radiolucency and gingival inflammation around implant over a short period of 30 months. Materials and Methods A total of 12 patients (8 male and 4 female), ranging in the age from 20 to 50 years, from March 2007 to June 2007, were evaluated for immediate implant placement into 22 fresh extraction sockets. Only maxillary and mandibular anterior teeth/roots (central incisors, lateral incisors and canines) were considered for replacement with implants. One piece implant with integrated abutment and integrated surface, non-submerged, threaded and tapered at apical 5 mm, sand-blasted and acid etched surfaced implants (HI-TEC TRX-OP Implants of Life Care Company) were used. Results The mobility was not present in any of the implants at all the follow up visits. There were 2 implants at 6 month, 1 implant at 12 month, 1 implant at 18 month visits, showing peri-implant radiolucency at some sites at bone to implant contact site. Severe gingival inflammation was not observed in any of the implant site. At every follow-up visit, every implant met the criteria of success and none was found to be failed over a 30 months duration i.e. 100% success rate was achieved by implants in immediate extraction socket. Conclusion The success rate of implant survival in this study was found 100%. These implants have fulfilled all the criteria of implant success and based on the defined criteria, the success rate of implants placed in immediate extraction sockets of anterior teeth compared favorably with the conventional implants. The early results of the present study showed that high survival rates with the implants in immediate extraction sockets can be achieved. PMID:26266220

Group B streptococci in women fitted with intrauterine devices.

PubMed Central

Mitchell, R G; Guillebaud, J; Day, D G

1977-01-01

A survey was made of group B streptococcal carriage at various sites in 100 women attending a clinic for the insertion of an intrauterine contraceptive device (IUD). Twenty-three women carried streptococci at one or more sites at the preinsertion visit, the vaginal carriage rate being 16%. Six months after insertion changes in carrier status were noted and there was evidence of a change of strain in four patients. Twenty-nine women were carriers at one or more sites at some stage of the study. There was no evidence that symptoms attributable to infection in patients fitted with an IUD were caused by group B streptococci. PMID:338639

Quantifying and visualizing site performance in clinical trials.

PubMed

Yang, Eric; O'Donovan, Christopher; Phillips, JodiLyn; Atkinson, Leone; Ghosh, Krishnendu; Agrafiotis, Dimitris K

2018-03-01

One of the keys to running a successful clinical trial is the selection of high quality clinical sites, i.e., sites that are able to enroll patients quickly, engage them on an ongoing basis to prevent drop-out, and execute the trial in strict accordance to the clinical protocol. Intuitively, the historical track record of a site is one of the strongest predictors of its future performance; however, issues such as data availability and wide differences in protocol complexity can complicate interpretation. Here, we demonstrate how operational data derived from central laboratory services can provide key insights into the performance of clinical sites and help guide operational planning and site selection for new clinical trials. Our methodology uses the metadata associated with laboratory kit shipments to clinical sites (such as trial and anonymized patient identifiers, investigator names and addresses, sample collection and shipment dates, etc.) to reconstruct the complete schedule of patient visits and derive insights about the operational performance of those sites, including screening, enrollment, and drop-out rates and other quality indicators. This information can be displayed in its raw form or normalized to enable direct comparison of site performance across studies of varied design and complexity. Leveraging Covance's market leadership in central laboratory services, we have assembled a database of operational metrics that spans more than 14,000 protocols, 1400 indications, 230,000 unique investigators, and 23 million patient visits and represents a significant fraction of all clinical trials run globally in the last few years. By analyzing this historical data, we are able to assess and compare the performance of clinical investigators across a wide range of therapeutic areas and study designs. This information can be aggregated across trials and geographies to gain further insights into country and regional trends, sometimes with surprising results. The use of operational data from Covance Central Laboratories provides a unique perspective into the performance of clinical sites with respect to many important metrics such as patient enrollment and retention. These metrics can, in turn, be used to guide operational planning and site selection for new clinical trials, thereby accelerating recruitment, improving quality, and reducing cost.

Pre‐moult patterns of habitat use and moult site selection by Brent Geese Branta bernicla nigricans: Individuals prospect for moult sites

USGS Publications Warehouse

Lewis, Tyler; Flint, Paul L.; Schmutz, Joel A.; Derksen, Dirk V.

2010-01-01

In environments where habitat quality varies, the mechanism by which individuals assess and select habitats has significant consequences on their spatial distribution and ability to respond to environmental change. Each year, thousands of Black Brent Geese Branta bernicla nigricans migrate to the Teshekpuk Lake Special Area (TLSA), Alaska, to undergo a flightless wing‐moult. Over the last three decades, moulting Brent Geese have changed their distribution within the TLSA, redistributing from inland, freshwater wetlands towards coastal, brackish wetlands. To understand better the mechanism by which Brent Geese select a moult site, as well as reasons behind the long‐term shift of moulting distributions, we examined movements and habitat use of birds marked with GPS‐transmitters during the pre‐moult period. Brent Geese did not generally migrate directly to their moulting site during the pre‐moult period, defined as the time from arrival at the moulting grounds to the onset of flightlessness. Rather, individuals used an average of 3.7 ± 0.6 (se) wetland complexes and travelled a minimum of 95.14 ± 15.84 km during the pre‐moult period. Moreover, 69% of Brent Geese visited their final moult site only to leave and visit other sites before returning for the flightless moult. Brent Geese spent significant time in both inland freshwater and coastal estuarine habitats during the pre‐moult, irrespective of the habitat in which they ultimately moulted. Whereas previous research suggested that Brent Geese choose moult sites based largely upon the experience of previous years, our observations suggest a mechanism of moult site selection whereby Brent Geese ‘prospect’ for moult sites, visiting multiple potential moult sites across varied habitat types, presumably gathering information from each site and correspondingly using this information to choose an appropriate moult site. By allowing individuals to adjust their distributions in response to habitat quality cues that may change annually, such as forage type and availability, prospecting may have influenced the long‐term shift in moulting distributions of Brent Geese in the TLSA.

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.

The States and Private Higher Education. Problems and Policies in a New Era. A Report of the Carnegie Council on Policy Studies in Higher Education.

ERIC Educational Resources Information Center

1977

A study was undertaken to assess the impact of existing state policies toward private higher education on enrollments, finances, autonomy, academic freedom, and other conditions of private institutions. The study included a survey of the presidents and their staffs of 230 institutions, site visits to 28 colleges and universities in five states,…

Access assured: a pilot program to finance primary care for uninsured patients using a monthly enrollment fee.

PubMed

Saultz, John W; Brown, David; Stenberg, Stephen; Rdesinski, Rebecca E; Tillotson, Carrie J; Eigner, Danielle; Devoe, Jennifer

2010-01-01

Access Assured is an experimental program being used by 2 academic family medicine practices to deliver primary care to an uninsured patient population using a monthly retainer payment system in addition to a sliding fee schedule for office visits. This prospective cohort study was designed to determine whether patients would join such a program, to describe the population of people who did so, and to assess the program's financial viability. We used data abstracted from our electronic medical record system to describe the demographic characteristics and care utilization patterns of those patients enrolling during the first year of the study, between February 1, 2008, and January 31, 2009. We also compared 2 subpopulations of enrollees defined by their eligibility for office fee discounts based on income. A total of 600 Access Assured members made 1943 office visits during the study period, receiving a total of 4538.22 relative value units of service. Based on the membership fee, office visit fee collections, and remaining accounts receivable, this resulted in an expected reimbursement rate of $42.88 per relative value units. Three hundred one of the 600 (50.2%) patients had incomes above 400% of the federal poverty level (FPL) at the time of each of their office visits and were therefore not eligible for any visit fee discount. Another 156 patients (26.0%) were eligible for a 100% discount of all visit fees based on their income below 200% of the FPL. Using a multivariable Poisson regression analysis of these 2 groups, we determined that age was a significant determinant of return visit rate, with a 0.7% increase in return visit rate for each additional year of age (P = .006). Women had a 26% higher return visit rate than men (P = .001). After accounting for age, sex, and clinic site, fee discount level based on income was not a significant independent determinant of return visit rate (P = .118). A retainer-based program to enroll uninsured patients being used in 2 academic family medicine clinics attracted 600 patients during its first year. The program was financially viable and resulted in an expansion of our service to uninsured patients. More than half of the patients had incomes above 400% of the FPL, suggesting that the population of uninsured Oregonians may be economically more diverse than suspected.

An Epidemiological Study of Hyperhidrosis Patients Visiting the Ajou University Hospital Hyperhidrosis Center in Korea

PubMed Central

Park, Eun Jung; Han, Kyung Ream; Choi, Ho; Kim, Do Wan

2010-01-01

Hyperhidrosis is a disorder of perspiration in excess of the body's physiologic need and significantly impacts one's occupational, physical, emotional, and social life. The purpose of our study was to investigate the characteristics of primary hyperhidrosis in 255 patients at Ajou University Hospital Hyperhidrosis Center from March 2006, to February 2008. Information collected from the medical records was: sex, sites of hyperhidrosis, age at visit, age of onset, aggravating factors, hyperhidrosis disease severity scale (HDSS) rank, family history, occupation, and past treatment. A total of 255 patient records were reviewed; 57.6% were male. Patients with a family history (34.1%) showed a lower age of onset (13.21±5.80 yr vs. 16.04±9.83 yr in those without family history); 16.5% had previous treatment, most commonly oriental medicine. Palmar and plantar sites were the most commonly affected, and 87.9% of patients felt their sweating was intolerable and always interfered with their daily activities. Our study provides some original information on the Korean primary hyperhidrosis population. Patients who have a family history show signs of disease in early age than those without family history. PMID:20436716

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.

The AIP Career Pathways Project: Learning the Effective Practices of Physics Departments Preparing Graduates with the Bachelor's Degree for STEM Careers

NASA Astrophysics Data System (ADS)

Olsen, Thomas; Redmond, Kendra; Czujko, Roman

2012-10-01

Forty percent of students graduating with the bachelor's degree in physics seek employment immediately upon graduation. The AIP Career Pathways Project, funded by NSF, seeks to learn by site visits the effective practices of departments in preparing these students to successfully secure positions in STEM and to make these practices known by presentations, publications, and workshops. This talk will review AIP Statistical Resources data on the careers of physicists with the bachelor's degree, provide preliminary insights from the site visits, provide some advice for graduates seeking employment, and describe the upcoming workshops.

A Study of the Extent and Effect of English Language Training for Refugees. Phase II: Classroom Observation and Community Survey.

ERIC Educational Resources Information Center

Reder, Stephen; Cohn, Mary

The second phase of a study of the impact of English language training programs on adult Southeast Asian refugees involved on-site visits to 22 intensive programs in eight metropolitan areas: San Diego, Seattle, Minneapolis/St. Paul, New Orleans, Oklahoma City, Northern Virginia/Washington, DC, and Stockton, California. Programs represented a wide…

Employer Recruitment Is Not the Problem: A Study of School-to-Work Transition Programs. IEE Brief Number 21.

ERIC Educational Resources Information Center

Hughes, Katherine L.

To study employer motivations for participating in school-to-work (STW) programs, researchers sought programs with a strong work-based learning component, specifically those where employers took students as interns or apprentices for one or two school years. In 1995 and 1996, 1 or 2 site visits were made to each of 12 programs. Researchers toured…

In-Firm Trainers of Young People in the Framework of the Dual Vocational Training System of the Federal Republic of Germany.

ERIC Educational Resources Information Center

von Gilardi, Rudiger; Schulz, Winfried

This study of the vocational training system in the Federal Republic of Germany was conducted by the European Centre for the Development of Vocational Training through site visits, seminars, research papers, and discussion. The study found that the majority of young people in the Federal Republic of Germany (currently 1.8 million) receive their…

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

PubMed

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

2013-03-01

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

Reducing Emergency Room Visits and In-Hospitalizations by Implementing Best Practice for Transitional Care Using Innovative Technology and Big Data.

PubMed

Hewner, Sharon; Sullivan, Suzanne S; Yu, Guan

2018-06-01

Efforts to improve care transitions require coordination across the healthcare continuum and interventions that enhance communication between acute and community settings. To improve post-discharge utilization value using technology to identify high-risk individuals who might benefit from rapid nurse outreach to assess social and behavioral determinants of health with the goal of reducing inpatient and emergency department visits. The project employed a before and after comparison of the intervention site with similar primary care practice sites using population-level Medicaid claims data. The intervention targeted discharged persons with preexisting chronic disease and delivered a care transition alert to a nurse care coordinator for immediate telephonic outreach. The nurse assessed social determinants of health and incorporated problems into the EHR to share across settings. The project evaluated health outcomes and the value of nursing care on existing electronic claims data to compare utilization in the years before and during the intervention using negative binomial regression to account for rare events such as inpatient visits. Avoiding readmissions and emergency visits, and increasing timely outpatient visits improved the individual's experience of care and the work life of healthcare providers, while reducing per capita costs (Quadruple Aim). In the intervention practice, the nurse care coordinator demonstrated the value of nursing care by reducing inpatient (25%) and emergency (35%) visits, and increasing outpatient visits (27%). The estimated value of avoided encounters over the secular Medicaid trend was $664 per adult with chronic disease, generating $71,289 in revenue from additional outpatient visits. Using health information exchange to deliver appropriate and timely evidence-based clinical decision support in the form of care transition alerts and assessment of social determinants of health, in conjunction with data science methods, demonstrates the value of nursing care and resulted in achieving the Quadruple Aim. © 2018 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.

How medical students use the computer and Internet at a Turkish military medical school.

PubMed

Kir, Tayfun; Ogur, Recai; Kilic, Selim; Tekbas, Omer Faruk; Hasde, Metin

2004-12-01

The aim of this study was to determine how medical students use the computer and World Wide Web at a Turkish military medical school and to discuss characteristics related to this computer use. The study was conducted in 2003 in the Department of Public Health at the Gulhane Military Medical School in Ankara, Turkey. A survey developed by the authors was distributed to 508 students, after pretest. Responses were analyzed statistically by using a computer. Most of the students (86.4%) could access a computer and the Internet and all of the computers that were used by students had Internet connections, and a small group (8.9%) had owned their own computers. One-half of the students use notes provided by attending stuff and textbooks as assistant resources for their studies. The most common usage of computers was connecting to the Internet (91.9%), and the most common use of the Internet was e-mail communication (81.6%). The most preferred site category for daily visit was newspaper sites (62.8%). Approximately 44.1% of students visited medical sites when they were surfing. Also, there was a negative correlation between school performance and the time spent for computer and Internet use (-0.056 and -0.034, respectively). It was observed that medical students used the computer and Internet essentially for nonmedical purposes. To encourage students to use the computer and Internet for medical purposes, tutors should use the computer and Internet during their teaching activities, and software companies should produce assistant applications for medical students. Also, medical schools should build interactive World Wide Web sites, e-mail groups, discussion boards, and study areas for medical students.

Factors that attract and repel visitation to urban recreation sites: a framework for research

Treesearch

David Klenosky; Cherie LeBlanc; Christine Vogt; Herbert Schroeder

2008-01-01

The mix of natural features and manmade elements in urban and metropolitan areas presents unique challenges for resource managers and planners. While some elements of the urban landscape (e.g., forested areas, parks, water features, and museums) may attract or encourage visitation, others (e.g., industrial and commercial activity, odors, noises, crime, litter, and...

Leveraging Collection Structure in Information Retrieval with Applications to Search in Conversational Social Media

ERIC Educational Resources Information Center

Elsas, Jonathan L.

2011-01-01

Social media collections are becoming increasingly important in the everyday life of Internet users. Recent statistics show that sites hosting social media and community-generated content account for five of the top ten most visited websites in the United States [4] are visited regularly by a broad cross-section of Internet users [61, 67, 115] and…

Stennis' granddaughter visits Mississippi Facility

NASA Image and Video Library

2009-04-06

Jane Kenna of Atlanta, granddaughter of the late Sen. John C. Stennis, stands with her husband, John, near a bust of her grandfather displayed in StenniSphere, the visitor center at NASA's John C. Stennis Space Center. Kenna visited Stennis on April 6, her first trip to the rocket engine testing facility since the 1988 ceremony to rename the site in honor of Stennis.

World Presidents Organization

NASA Technical Reports Server (NTRS)

2010-01-01

Mississippi Gov. Haley Barbour speaks to members of the World Presidents' Organization during the group's visit to NASA's John C. Stennis Space Center on Jan. 26. WPO members from several states spent the day touring Stennis facilities and learning about the work of the nation's premier rocket engine testing site. Barbour visited with group members during a morning session in StenniSphere, the center's visitors center and museum.

World Presidents Organization

NASA Image and Video Library

2010-01-26

Mississippi Gov. Haley Barbour speaks to members of the World Presidents' Organization during the group's visit to NASA's John C. Stennis Space Center on Jan. 26. WPO members from several states spent the day touring Stennis facilities and learning about the work of the nation's premier rocket engine testing site. Barbour visited with group members during a morning session in StenniSphere, the center's visitors center and museum.

2012 Take Our Children to Work Day

NASA Image and Video Library

2012-07-31

More than 250 children of employees at 15 Stennis Space Center resident agencies and organizations visited the facility July 31 to participate in annual Take Our Children to Work Day activities. Participants enjoyed various presentations and demonstrations on topics such as cryogenics and information security. They also had an opportunity to visit site facilities to learn about various work performed at the NASA center.

Reading, Learning and Enacting: Interpretation at Visitor Sites in the Wet Tropics Rainforest of Australia

ERIC Educational Resources Information Center

McNamara, Karen Elizabeth; Prideaux, Bruce

2010-01-01

The northern Wet Tropics rainforest of Australia was declared a world heritage site in 1988 and now supports an extensive tourism industry that attracts an estimated 2.5 million local and international visits annually. As part of the visitor experience, many sites include both environmental and cultural interpretation experiences, which range from…

Commentary: Online Reviews and Other Digital Marketing Strategies.

PubMed

Levin, Roger P

2017-02-01

As getting patient reviews posted on online sites appears problematic for periodontal practices, the author urges periodontists to encourage patients to review their practices online on Yelp and other sites. The more positive online reviews practices receive, the higher the rankings on review sites, which will translate into more website visits and, ultimately, more new patient appointments.

Feasibility of using a web-based nutrition intervention among residents of multiethnic working-class neighborhoods.

PubMed

McNeill, Lorna H; Viswanath, K; Bennett, Gary G; Puleo, Elaine; Emmons, Karen M

2007-07-01

Using the Internet to promote behavior change is becoming more desirable as Internet use continues to increase among diverse audiences. Yet we know very little about whether this medium is useful or about different strategies to encourage Internet use by various populations. This pilot study tested the usefulness of a Web-based intervention designed to deliver nutrition-related information to and increase fruit and vegetable consumption among adults from working-class neighborhoods. Participants (N = 52) had access to the Web site for 6 weeks and received three e-mail reminders encouraging them to eat fruits and vegetables. The Web site provided information about overcoming barriers to healthy eating, accessing social support for healthy eating, setting goals for healthy eating, and maintaining a healthy diet, including recipes. We collected data on participants' use of the Web site, their Internet access and use, and their fruit and vegetable consumption. The mean age of the participants was 46 years, 73% were white, 46% did not have a college degree, and 12% had household incomes at or below 185% of the federal poverty index. They reported consuming an average of 3.4 servings of fruits and vegetables per day. More than half of the participants owned a computer, 75% logged onto the Web site at least once, and those who visited the site averaged 3.8 visits and viewed an average of 24.5 pages. The number of log-ons per day declined over the study period; however, reminder e-mails appeared to motivate participants to return to the Web site. Roughly 74% of participants viewed information on goal setting, 72% viewed information on dietary tracking, and 56% searched for main course recipes. The results of this pilot study suggest that Internet-based health messages have the potential to reach a large percentage of adults from working-class neighborhoods who have access to the Internet.

Racial-Ethnic Differences in Health Service Use in a Large Sample of Homeless Adults With Mental Illness From Five Canadian Cities.

PubMed

Stergiopoulos, Vicky; Gozdzik, Agnes; Nisenbaum, Rosane; Vasiliadis, Helen-Maria; Chambers, Catharine; McKenzie, Kwame; Misir, Vachan

2016-09-01

This study examined factors associated with health care use in an ethnically diverse Canadian sample of homeless adults with mental illness, a particularly disadvantaged group. Baseline survey data were available from five sites across Canada for 2,195 At Home/Chez Soi demonstration project participants. Negative binomial regression models examined the relationship between racial-ethnic or cultural group membership (white, N=1,085; Aboriginal, N=476; black, N=244; and other ethnoracial minority groups, N=390) and self-reported emergency department (ED) visits and hospitalizations in the past six months and past-month visits to a medical, other clinical, or social service provider. Adjusted models included other predisposing, enabling, and need factors, based on Andersen's behavioral model for vulnerable populations. Compared with white participants, black participants had a lower rate of ED visits (adjusted rate ratio [ARR]=.54, 95% confidence interval [CI]=.43-.69) and Aboriginal participants had a lower rate of medical visits (ARR=.84, CI=.71-.99) and a higher rate of visits to social service providers (ARR=1.54, CI=1.18-2.01). Participants in other ethnoracial minority groups had a higher rate of social service provider visits than white participants (ARR=1.44, CI=1.10-1.89). Access to a family physician, having at least high school education, and high needs for mental health services were associated with greater use of ED and medical visits and hospitalizations. Rates of ED and medical visits were lower with increased age and better physical health. In a system of universal health insurance that prioritizes access to and quality of care, the presence of racial-ethnic disparities experienced by this vulnerable population merits further attention.

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

ERIC Educational Resources Information Center

Miron, Gary; Nelson, Christopher; Risley, John

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

Pollinators of the invasive plant, yellow starthistle (Centaurea solstitialis), in north-eastern Oregon, USA

Treesearch

James McIver; Robbin Thorp; Karen Erickson

2009-01-01

The potential pollinators of yellow starthistle (Centaurea solstitialis) were surveyed at six sites in north-eastern Oregon, USA, between May and September from 2000 to 2002. The objective of the study was to determine the species composition and relative abundance of the insects that visited yellow starthistle throughout the flowering season and...

Departmental Assessment: How Some Campuses Are Effectively Evaluating the Collective Work of Faculty.

ERIC Educational Resources Information Center

Wergin, Jon F.; Swingen, Judi N.

This study assessed the ways in which academic departments in U.S. colleges and universities are evaluated through a survey of about 130 institutions across the Carnegie university categories. This survey and literature review were supplemented by site visits to eight universities. The authors were surprised to find a great amount of departmental…

Interpretive Studies on Bilingual Education. Final Report.

ERIC Educational Resources Information Center

Ulibarri, Horacio

This project, carried out in 1968-1969, undertook as its main purposes (1) to review the research that has been conducted on bilingual education; (2) to obtain the recommendations on bilingual education from those persons who have been actively engaged in working with this problem; (3) to conduct on-site visitations to see at first hand programs…

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…

Evaluation of Calipers II: Using Simulations to Assess Complex Learning Site Visit Findings. CRESST Report 821

ERIC Educational Resources Information Center

Matrundola, Deborah La Torre; Chang, Sandy; Herman, Joan

2012-01-01

The purpose of these case studies was to examine the ways technology and professional development supported the use of the SimScientists assessment systems. Qualitative research methodology was used to provide narrative descriptions of six classes implementing simulation-based assessments for either the topic of Ecosystems or Atoms and Molecules.…

Promoting Students' Interest and Motivation towards Science Learning: The Role of Personal Needs and Motivation Orientations

ERIC Educational Resources Information Center

Loukomies, Anni; Pnevmatikos, Dimitris; Lavonen, Jari; Spyrtou, Anna; Byman, Reijo; Kariotoglou, Petros; Juuti, Kalle

2013-01-01

This study aimed to design a teaching sequence for science education that enabled lower secondary school students to enhance their motivation towards science. Further, it looked to examine the way the designed teaching sequence affected students with different motivational profiles. Industry site visits, with embodied theory-based motivational…

Effects on consumer welfare of visitor satisfaction information: a case study of the Allegheny National Forest

Treesearch

Seong-Hoon Cho; Michael Bowker; Roland K.  Roberts; Seunggyu  Kim; Taeyoung  Kim; Dayton M.  Lambert

2015-01-01

This research quantifies changes in consumer welfare due to changes in visitor satisfaction with the availability of information about recreational sites. The authors tested the hypothesis that an improvement in visitor satisfaction with recreation information increases the number of visits to national forests, resulting in increased consumer welfare. They...

Seniors Online: Online Literacy and Learning by Senior Citizens in Rural Centres.

ERIC Educational Resources Information Center

Millar, Pat; Falk, Ian

The learning needs of older adults living in rural Tasmania, Australia, and the potential of online technologies to foster local literacy and community well-being were examined. The study used a qualitative inquiry strategy that included visits to three sites to investigate the literacy and numeracy implications of senior citizens' use of online…

These Women Make a Difference in Our Lives | Poster

Cancer.gov

By Maritta Perry Grau, Staff Writer Producing viral vectors for in vitro and in vivo studies, evaluating new technologies, organizing outreach and internal events and special programs, preparing site visit reports, helping make newcomers feel comfortable, collaborating on statistics and other projects—these are just some of the ways that the women of the Frederick National

Home Start Evaluation Study. Interim Report II: Program Analysis. Revised Draft.

ERIC Educational Resources Information Center

Deloria, Dennis; And Others

This document is the second in a series of evaluative reports directed to evaluation needs of Home Start planners and administrators. It focuses on implementation data about programs gathered during local site visits conducted in the spring and fall of 1972. The two basic evaluative questions asked are: (1) What was Home Start intended by its…

It's All Business: A Site Visit Report on Working Order, Sharpsburg, Pennsylvania.

ERIC Educational Resources Information Center

Olney, Marjorie F.; Harris, Perri

This report discusses the results of a case study of Working Order, a Pennsylvania program designed to develop entrepreneurs with and without disabilities by sharing the expertise, resources, and skills of small business owners. The strategy of the program is to invite competitive entrepreneurs, those who could likely produce and sell their…

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…

California Community College Handbook: Teaching Basic Skills in Vocational Education. Model Programs.

ERIC Educational Resources Information Center

Evaluation and Training Inst., Los Angeles, CA.

This handbook was produced as a result of a project that studied California community college programs that teach basic skills in vocational education programs. The project included a literature review, a telephone survey, and 12 site visits. The handbook contains four sections: (1) steps for integrating basic skills and vocational instruction;…

Results of Descriptive Study of Crisis Nursery and Respite Care Programs.

ERIC Educational Resources Information Center

Huntington, Gail S.; And Others

This report describes results of an evaluation of respite care programs and crisis nursery programs for children with disabilities, based on survey forms received from 81 programs and site visits to selected programs across the United States. The survey of crisis nursery programs and the survey of respite care programs gathered data on amount of…

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…

Maryland's Graduation Requirements: Local Effects of Policy Reform.

ERIC Educational Resources Information Center

Wilson, Bruce L.; And Others

In 1985, Maryland became one of 45 states that enacted new and tougher graduation requirements. This document presents findings of a 4-year study that examined the effects of the new requirements on local schools and the students and staff who work in them. Three site visits each were made to five selected high schools. Data collection included:…

Diet of nestling red-cockaded woodpeckers at three locations

Treesearch

James L. Hanula; Donald Lipscomb; Kathleen E. Franzreb; Susan C. Loeb

2000-01-01

We conducted a 2-yr study of the nestling diet of red-cockaded woodpeckers (Picoides borealis) at three locations to determine how it varied among sites. We photographed 5939 nest visits by adult woodpeckers delivering food items for nestlings. In 1994, we located cameras near three nest cavities on the Lower Coastal Plain of South Carolina and near...

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

PubMed

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

2011-07-01

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

Sex Differences in Prevalence of Emergency Department Patient Substance Use.

PubMed

Cannon, Robert D; Beauchamp, Gillian A; Roth, Paige; Stephens, Jennifer; Burmeister, David B; Richardson, David M; Balbi, Alanna M; Park, Tennessee D; Dusza, Stephen W; Greenberg, Marna Rayl

2018-02-01

Substance use and misuse is prevalent in emergency department (ED) populations. While the prevalence of substance use and misuse is reported, sex-specific trends in ED populations have not been documented. We set out to determine the sex-specific prevalence of ED patient substance use during this current epidemic. A retrospective electronic data abstraction tool, developed for quality-improvement purposes, was used to assess ED visits in 3 hospitals in northeastern Pennsylvania. All patients with ED diagnosis codes for substance use F10.000 through F 19.999 (excluding F17 codes for nicotine) were abstracted for network ED visits at all 3 hospitals. Data points included ED clinical enrollment site, primary substance used, sex, date of ED visit, disposition (including left without being seen, left against medical advice, discharged, admitted, and treatment in rehabilitation) for 18 months (January 1, 2016 through July 31, 2017). The categorical parameters of sex, clinical enrollment site, diagnosis, date of ED visit, and disposition status were summarized as a proportion of the subject group. Time series analysis was used to assess trends in substance use and misuse visits by patient sex. A total of 10,511 patients presented to the EDs during the study time period with a final diagnosis of a substance use-related reason and were included in the analysis. The mean age for these patients was 43.6 (SD 16.4) years, and the majority was male (65.6%, n = 6900). The most common substance in the final diagnosis for the ED visit was alcohol (54.3%; 95% CI, 53.3-55.2), followed by opioids (19.2%; 95% CI, 18.4-19.9) and cannabis (14.4%; 95% CI, 13.7-15.0). Females tended to be younger than males (42.4 years vs 44.3 years; P < 0.001), and were more likely to be discharged after the ED visit than males (36.1% vs 32.3%; P < 0.001). When exploring differences in age by sex and substance, males with a final diagnosis including alcohol- and cannabis-related issues were older than females, whereas females diagnosed with opioid-related reasons were older than males (41.3 vs 38.9 years; P < 0.001). There are sex-specific differences in prevalence of patients presenting with substance use in the ED setting. Copyright © 2018 Elsevier HS Journals, Inc. All rights reserved.

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.

Bringing home sustainability and climate change research and developments via on-line virtual reality

NASA Astrophysics Data System (ADS)

Granshaw, F. D.

2016-12-01

One of the key challenges of sustainability and climate education is one of accessibility. For example many of the sites where significant climate research is taking place in National Parks are largely inaccessible to the average park visitor. Likewise, taking students to visit exemplary efforts in environmentally sustainable design or habitat restoration projects may be logistically difficult or impossible for the average class. Yet despite these difficulties, finding ways to give students, park visitors, and the general public a chance to explore these areas is critical to their developing sustainability and climate literacy. To address this issue, the author has been working with National Park staff and community groups to develop desktop virtual reality environments that showcase glacier-climate research sites, developments designed with environmental sustainability in mind, and urban watersheds being rehabilitated by volunteer groups and public agencies. These environments provide the user with a chance to take a virtual walk through a site of interest, access data collected at the site, and even listen to researchers and site stewards talk about key activities taking place there. Though they are used as proxies for actual visits via independent on-line exploration, media for public talks, or the framework for student lab exercises, they these virtual environments have also been used to encourage and guide actual sites visits. A focus of this talk will be a recently launched project involving the construction of a library showcasing environmental sustainability projects in the Portland Metropolitan area. In addition to being a resource for local sustainability educators, the library will be a contribution to international sustainability education efforts as it is being developed under the umbrella of a UN affiliate (Greater Portland Sustainability Education Network).

Low-Level Laser Therapy in Enhancing Wound Healing and Preserving Tissue Thickness at Free Gingival Graft Donor Sites: A Randomized, Controlled Clinical Study.

PubMed

Ustaoglu, Gulbahar; Ercan, Esra; Tunali, Mustafa

2017-04-01

The aim of this study was to determine the effects of low-level laser therapy (LLLT) on wound healing at free gingival graft (FGG) donor sites. Forty patients requiring FGG were selected for this randomized, controlled, and double-blinded prospective clinical trial. The FGG donor sites were treated with LLLT and compared with an untreated control group. The Wound-Healing Index (WHI), tissue consistency, color match, and H 2 O 2 bubbling test for the evaluation of complete wound epithelialization were recorded on the 3rd, 7th, 14th and 21st days. The pain-burning level, number of analgesics, and bleeding were recorded for 7 days. Donor area soft tissue thickness (TT) was measured at baseline and at the first month. The prevalence of Complete Wound Epithelization was higher in the LLLT group than in the control group on the 14th day (p < 0.001). The bleeding was lower in the test group than in the control group during the first 2 days (p ≤ 0.001). Higher WHI Scores were observed in the test group relative to the control group at all visits (p ≤ 0.001). Color match scores were higher in the test group than in the control group at the first 3 visits (p < 0.05). The TT changed from 4.62 ± 0.79 to 4.71 ± 0.82 mm in the LLLT group and from 4.23 ± 0.62 to 4.01 ± 0.68 mm in the control group. It can be concluded that LLLT enhances FGG donor site wound healing and preserves TT at palatinal donor sites.

Quality and accuracy of sexual health information web sites visited by young people.

PubMed

Buhi, Eric R; Daley, Ellen M; Oberne, Alison; Smith, Sarah A; Schneider, Tali; Fuhrmann, Hollie J

2010-08-01

We assessed online sexual health information quality and accuracy and the utility of web site quality indicators. In reviewing 177 sexual health web sites, we found below average quality but few inaccuracies. Web sites with the most technically complex information and/or controversial topics contained the most inaccuracies. We found no association between inaccurate information and web site quality. (c) 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Psychosocial factors associated with early initiation and frequency of antenatal care (ANC) visits in a rural and urban setting in South Africa: a cross-sectional survey.

PubMed

Muhwava, Lorrein Shamiso; Morojele, Neo; London, Leslie

2016-01-25

Late booking and infrequent antenatal care (ANC) are common but avoidable patient-related risk factors for maternal deaths in South Africa. The aim of the study was to examine the association of psychosocial factors with early initiation of ANC and adequate frequency of attendance of ANC clinics among women in an urban and rural location in South Africa. Data from a 2006 cross-sectional household survey of 363 women from the rural Western Cape and 466 women from urban Gauteng provinces of South Africa for risk of alcohol-exposed pregnancy were analysed. We examined associations between psychosocial variables (self-esteem, cultural influences, religiosity, social capital, social support, pregnancy desire (wanted versus unwanted pregnancy), partner characteristics and mental health) and both early ANC first visit (before 16 weeks) and adequate frequency of ANC visits (4 or more visits) for respondents' last pregnancy. Overall prevalence among urban women of early ANC initiation was 46% and 84% for adequate ANC frequency. Overall prevalence among rural women of early ANC initiation was 45% and 78% for adequate ANC frequency. After adjusting for clustering, psychosocial factors associated with early ANC initiation in the urban site were being employed (OR 1.6; 95% CI 1.0-2.5) and wanted pregnancy (OR 1.8; 95% CI 1.1-3.0). For the rural site, early ANC initiation was significantly associated with being married (OR 1.93; 95% CI 1.0-3.6) but inversely associated with high religiosity (OR 0.5; 95% CI 0.3-0.8). Adequate frequency of ANC attendance in the rural site was associated with wanted pregnancy (OR 4.2; 95% CI 1.9-9.3) and the father of the child being present in the respondent's life (OR 3.0; 95% CI 1.0-9.0) but inversely associated with having a previous miscarriage (OR 0.4; 95% CI 0.2-0.8). There were no significant associations between adequate ANC attendance and the psychosocial factors in the urban site. The majority of women from both sites attended ANC frequently but less than 50% initiated ANC before the recommended 16 weeks gestational age. Interventions to reduce prevalence of late ANC booking and inadequate ANC attendance should engage religious leaders, address unintended pregnancy through family planning education and involve male partners in women's reproductive health.

Effects of organizational complexity and resources on construction site risk.

PubMed

Forteza, Francisco J; Carretero-Gómez, Jose M; Sesé, Albert

2017-09-01

Our research is aimed at studying the relationship between risk level and organizational complexity and resources on constructions sites. Our general hypothesis is that site complexity increases risk, whereas more resources of the structure decrease risk. A Structural Equation Model (SEM) approach was adopted to validate our theoretical model. To develop our study, 957 building sites in Spain were visited and assessed in 2003-2009. All needed data were obtained using a specific tool developed by the authors to assess site risk, structure and resources (Construction Sites Risk Assessment Tool, or CONSRAT). This tool operationalizes the variables to fit our model, specifically, via a site risk index (SRI) and 10 organizational variables. Our random sample is composed largely of small building sites with general high levels of risk, moderate complexity, and low resources on site. The model obtained adequate fit, and results showed empirical evidence that the factors of complexity and resources can be considered predictors of site risk level. Consequently, these results can help companies, managers of construction and regulators to identify which organizational aspects should be improved to prevent risks on sites and consequently accidents. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Effects of naloxone distribution to likely bystanders: Results of an agent-based model.

PubMed

Keane, Christopher; Egan, James E; Hawk, Mary

2018-05-01

Opioid overdose deaths in the US rose dramatically in the past 16 years, creating an urgent national health crisis with no signs of immediate relief. In 2017, the President of the US officially declared the opioid epidemic to be a national emergency and called for additional resources to respond to the crisis. Distributing naloxone to community laypersons and people at high risk for opioid overdose can prevent overdose death, but optimal distribution methods have not yet been pinpointed. We conducted a sequential exploratory mixed methods design using qualitative data to inform an agent-based model to improve understanding of effective community-based naloxone distribution to laypersons to reverse opioid overdose. The individuals in the model were endowed with cognitive and behavioral variables and accessed naloxone via community sites such as pharmacies, hospitals, and urgent-care centers. We compared overdose deaths over a simulated 6-month period while varying the number of distribution sites (0, 1, and 10) and number of kits given to individuals per visit (1 versus 10). Specifically, we ran thirty simulations for each of thirteen distribution models and report average overdose deaths for each. The baseline comparator was no naloxone distribution. Our simulations explored the effects of distribution through syringe exchange sites with and without secondary distribution, which refers to distribution of naloxone kits by laypersons within their social networks and enables ten additional laypersons to administer naloxone to reverse opioid overdose. Our baseline model with no naloxone distribution predicted there would be 167.9 deaths in a six month period. A single distribution site, even with 10 kits picked up per visit, decreased overdose deaths by only 8.3% relative to baseline. However, adding secondary distribution through social networks to a single site resulted in 42.5% fewer overdose deaths relative to baseline. That is slightly higher than the 39.9% decrease associated with a tenfold increase in the number of sites, all distributing ten kits but with no secondary distribution. This suggests that, as long as multiple kits are picked up per visit, adding secondary distribution is at least as effective as increasing sites from one to ten. Combining the addition of secondary distribution with an increase in sites from one to ten resulted in a 61.1% drop in deaths relative to the baseline. Adding distribution through a syringe exchange site resulted in a drop of approximately 65% of deaths relative to baseline. In fact, when enabling distribution through a clean-syringe site, the secondary distribution through networks contributed no additional drops in deaths. Community-based naloxone distribution to reverse opioid overdose may significantly reduce deaths. Optimal distribution methods may include secondary distribution so that the person who picks up naloxone kits can enable others in the community to administer naloxone, as well as targeting naloxone distribution to sites where individuals at high-risk for opioid overdose death are likely to visit, such as syringe-exchange programs. This study design, which paired exploratory qualitative data with agent-based modeling, can be used in other settings seeking to implement and improve naloxone distribution programs. Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.

Monitoring worksite clinic performance using a cost-benefit tool.

PubMed

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

2009-10-01

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

76 FR 80377 - Notice of Submission of Proposed Information Collection to OMB Additional On-Site Data Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-23

... with PHA staff and reviews of client files and administrative data collected by the PHA. The results of... reviews of client files and administrative data collected by the PHA. The results of the site visits will...

KSC-04pd0837

NASA Image and Video Library

2004-04-13

KENNEDY SPACE CENTER, FLA. - Center Director Jim Kennedy (right) talks to Aaron Fernander, principal of Ralph Bunche Middle School, a NASA Explorer School, in Atlanta, Ga. Kennedy is visiting NES sites to share America’s new vision for space exploration with the next generation of explorers. He was accompanied by astronaut Rick Linnehan on the visit. The purpose of the school visit is to talk with students about our destiny as explorers, NASA’s stepping stone approach to exploring Earth, the Moon, Mars and beyond, how space impacts our lives, and how people and machines rely on each other in space.

KSC-04pd0839

NASA Image and Video Library

2004-04-13

KENNEDY SPACE CENTER, FLA. - Center Director Jim Kennedy talks to students and faculty at Ralph Bunche Middle School, a NASA Explorer School, in Atlanta, Ga. Kennedy is visiting NES sites to share America’s new vision for space exploration with the next generation of explorers. He was accompanied by astronaut Rick Linnehan on the visit. The purpose of the school visit is to talk with students about our destiny as explorers, NASA’s stepping stone approach to exploring Earth, the Moon, Mars and beyond, how space impacts our lives, and how people and machines rely on each other in space.

Neonatal care in a Japanese NICU: notes based on a site visit.

PubMed

Chirinian, Nevart; Uji, Atsuko; Isayama, Tetsuya; Shah, Vibhuti

2012-01-01

This article presents an overview of a neonatal intensive care unit along with resuscitative care and management of the 22 to 23 weeks gestational age infant is as it was noted during a visit to the NICU of a large academic center in Japan. Non-English speaking neonatology communities may be at a disadvantage of having their research and practices well known in the English speaking ones. Thus, visits such as this are beneficial in exchanging ideas and practices that may ultimately be mutually beneficial in reducing mortality and morbidity in a specific category of neonates.

Travel-related infections in children.

PubMed

Fox, Thomas G; Manaloor, John J; Christenson, John C

2013-04-01

Malaria, diarrhea, respiratory infections, and cutaneous larva migrans are common travel-related infections observed in children and adolescents returning from trips to developing countries. Children visiting friends and relatives are at the highest risk because few visit travel clinics before travel, their stays are longer, and the sites they visit are more rural. Clinicians must be able to prepare their pediatric-age travelers before departure with preventive education, prophylactic and self-treating medications, and vaccinations. Familiarity with the clinical manifestations and treatment of travel-related infections will secure prompt and effective therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

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

Economic tour package model using heuristic

NASA Astrophysics Data System (ADS)

Rahman, Syariza Abdul; Benjamin, Aida Mauziah; Bakar, Engku Muhammad Nazri Engku Abu

2014-07-01

A tour-package is a prearranged tour that includes products and services such as food, activities, accommodation, and transportation, which are sold at a single price. Since the competitiveness within tourism industry is very high, many of the tour agents try to provide attractive tour-packages in order to meet tourist satisfaction as much as possible. Some of the criteria that are considered by the tourist are the number of places to be visited and the cost of the tour-packages. Previous studies indicate that tourists tend to choose economical tour-packages and aiming to visit as many places as they can cover. Thus, this study proposed tour-package model using heuristic approach. The aim is to find economical tour-packages and at the same time to propose as many places as possible to be visited by tourist in a given geographical area particularly in Langkawi Island. The proposed model considers only one starting point where the tour starts and ends at an identified hotel. This study covers 31 most attractive places in Langkawi Island from various categories of tourist attractions. Besides, the allocation of period for lunch and dinner are included in the proposed itineraries where it covers 11 popular restaurants around Langkawi Island. In developing the itinerary, the proposed heuristic approach considers time window for each site (hotel/restaurant/place) so that it represents real world implementation. We present three itineraries with different time constraints (1-day, 2-day and 3-day tour-package). The aim of economic model is to minimize the tour-package cost as much as possible by considering entrance fee of each visited place. We compare the proposed model with our uneconomic model from our previous study. The uneconomic model has no limitation to the cost with the aim to maximize the number of places to be visited. Comparison between the uneconomic and economic itinerary has shown that the proposed model have successfully achieved the objective that minimize the tour cost and cover maximum number of places to be visited.

Pyrimethamine significantly lowers cerebrospinal fluid Cu/Zn superoxide dismutase in amyotrophic lateral sclerosis patients with SOD1 mutations.

PubMed

Lange, Dale J; Shahbazi, Mona; Silani, Vincenzo; Ludolph, Albert C; Weishaupt, Jochen H; Ajroud-Driss, Senda; Fields, Kara G; Remanan, Rahul; Appel, Stanley H; Morelli, Claudia; Doretti, Alberto; Maderna, Luca; Messina, Stefano; Weiland, Ulrike; Marklund, Stefan L; Andersen, Peter M

2017-06-01

Cu/Zn superoxide dismutase (SOD1) reduction prolongs survival in SOD1-transgenic animal models. Pyrimethamine produces dose-dependent SOD1 reduction in cell culture systems. A previous phase 1 trial showed pyrimethamine lowers SOD1 levels in leukocytes in patients with SOD1 mutations. This study investigated whether pyrimethamine lowered SOD1 levels in the cerebrospinal fluid (CSF) in patients carrying SOD1 mutations linked to familial amyotrophic lateral sclerosis (fALS/SOD1). A multicenter (5 sites), open-label, 9-month-duration, dose-ranging study was undertaken to determine the safety and efficacy of pyrimethamine to lower SOD1 levels in the CSF in fALS/SOD1. All participants underwent 3 lumbar punctures, blood draw, clinical assessment of strength, motor function, quality of life, and adverse effect assessments. SOD1 levels were measured in erythrocytes and CSF. Pyrimethamine was measured in plasma and CSF. Appel ALS score, ALS Functional Rating Scale-Revised, and McGill Quality of Life Single-Item Scale were measured at screening, visit 6, and visit 9. We enrolled 32 patients; 24 completed 6 visits (18 weeks), and 21 completed all study visits. A linear mixed effects model showed a significant reduction in CSF SOD1 at visit 6 (p < 0.001) with a mean reduction of 13.5% (95% confidence interval [CI] = 8.4-18.5) and at visit 9 (p < 0.001) with a mean reduction of 10.5% (95% CI = 5.2-15.8). Pyrimethamine is safe and well tolerated in ALS. Pyrimethamine is capable of producing a significant reduction in total CSF SOD1 protein content in patients with ALS caused by different SOD1 mutations. Further long-term studies are warranted to assess clinical efficacy. Ann Neurol 2017;81:837-848. © 2017 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association.

Is floral diversification associated with pollinator divergence? Flower shape, flower colour and pollinator preference in Chilean Mimulus.

PubMed

Cooley, A M; Carvallo, G; Willis, J H

2008-04-01

Adaptation to different pollinators is thought to drive divergence in flower colour and morphology, and may lead to interspecific reproductive isolation. Floral diversity was tested for association with divergent pollinator preferences in a group of four closely related wildflower species: the yellow-flowered Mimulus luteus var. luteus and the red-pigmented M. l. variegatus, M. naiandinus and M. cupreus. Patterns of pollinator visitation were evaluated in natural plant populations in central Chile, including both single-species and mixed-species sites. Floral anthocyanin pigments were identified, and floral morphology and nectar variation were quantified in a common garden experiment using seeds collected from the study sites. Mimulus l. luteus, M. l. variegatus and M. naiandinus are morphologically similar and share a single generalist bumblebee pollinator, Bombus dahlbomii. Mimulus cupreus differs significantly from the first three taxa in corolla shape as well as nectar characteristics, and had far fewer pollinator visits. This system shows limited potential for pollinator-mediated restriction of gene flow as a function of flower colour, and no evidence of transition to a novel pollinator. Mimulus cupreus may experience reduced interspecific gene flow due to a lack of bumblebee visitation, but not because of its red pigmentation: rare yellow morphs are equally undervisited by pollinators. Overall, the results suggest that factors other than pollinator shifts may contribute to the maintenance of floral diversity in these Chilean Mimulus species.

[A Study on the Number of Offices for Home-Visit/Outpatient Day Long-Term Care in Noto Area, Based on Estimated Population - Analysis Using the Geographic Information System].

PubMed

Itatani, Tomoya; Horiike, Ryo; Nakai, Hisao; Kyota, Kaoru; Tsukasaki, Keiko

2018-03-01

There has been a noticeable population decline in the Noto area. The Ministry of Land, Infrastructure, Transport and Tourism has determined the population size necessary for the establishment of daily living-related service businesses and, if the population falls below this, there is a possibility of businesses withdrawing from the area. In this research, we examine the number of home visit and daycare businesses established in the Noto area in 2025, using the geographic information system (GIS). The number of sites of businesses established was calculated using data published by the National Institute of Population and Social Security Research, and the Ministry of Land, Infrastructure, Transport and Tourism. Next, I depicted a buffer with a radius of 15 km from the establishment and confirmed the blank area of the service. Under the condition that the placement of sites is 80%, almost all the municipalities have exceeded the number of home visit care facilities and the number of daycare facilities. In the buffer analysis, blank areas were found in the north. To maintain these services, efforts by groups other than profit-oriented organizations are necessary, especially in the north of Noto. Route analysis by GIS and the consideration of population distribution and location of business establishment will be needed.

Prospective analysis of the quality of Spanish health information web sites after 3 years.

PubMed

Conesa-Fuentes, Maria C; Hernandez-Morante, Juan J

2016-12-01

Although the Internet has become an essential source of health information, our study conducted 3 years ago provided evidence of the low quality of Spanish health web sites. The objective of the present study was to evaluate the quality of Spanish health information web sites now, and to compare these results with those obtained 3 years ago. For the original study, the most visited health information web sites were selected through the PageRank® (Google®) system. The present study evaluated the quality of the same web sites from February to May 2013, using the method developed by Bermúdez-Tamayo et al. and HONCode® criteria. The mean quality of the selected web sites was low and has deteriorated since the previous evaluation, especially in regional health services and institutions' web sites. The quality of private web sites remained broadly similar. Compliance with privacy and update criteria also improved in the intervening period. The results indicate that, even in the case of health web sites, design or appearance is more relevant to developers than quality of information. It is recommended that responsible institutions should increase their efforts to eliminate low-quality health information that may further contribute to health problems.

Development and Assessment of Student Social/Civic Responsibility and Ethical Reasoning. TLTC Paper No. 5. CRLT Occasional Paper No. 36

ERIC Educational Resources Information Center

Hallman, Samantha K.

2016-01-01

University of Michigan (U-M) students visit community-based organizations in Detroit on a weekly basis to work on projects aimed at improving the well being of children and their families, such as tutoring youth in after school programs. Their site visits are supplemented by relevant readings, class discussions and written reflections on topics…

Spatial and Temporal Dynamics and Value of Nature-Based Recreation, Estimated via Social Media.

PubMed

Sonter, Laura J; Watson, Keri B; Wood, Spencer A; Ricketts, Taylor H

2016-01-01

Conserved lands provide multiple ecosystem services, including opportunities for nature-based recreation. Managing this service requires understanding the landscape attributes underpinning its provision, and how changes in land management affect its contribution to human wellbeing over time. However, evidence from both spatially explicit and temporally dynamic analyses is scarce, often due to data limitations. In this study, we investigated nature-based recreation within conserved lands in Vermont, USA. We used geotagged photographs uploaded to the photo-sharing website Flickr to quantify visits by in-state and out-of-state visitors, and we multiplied visits by mean trip expenditures to show that conserved lands contributed US $1.8 billion (US $0.18-20.2 at 95% confidence) to Vermont's tourism industry between 2007 and 2014. We found eight landscape attributes explained the pattern of visits to conserved lands; visits were higher in larger conserved lands, with less forest cover, greater trail density and more opportunities for snow sports. Some of these attributes differed from those found in other locations, but all aligned with our understanding of recreation in Vermont. We also found that using temporally static models to inform conservation decisions may have perverse outcomes for nature-based recreation. For example, static models suggest conserved land with less forest cover receive more visits, but temporally dynamic models suggest clearing forests decreases, rather than increases, visits to these sites. Our results illustrate the importance of understanding both the spatial and temporal dynamics of ecosystem services for conservation decision-making.

A Qualitative Evidence of the Breeding Sites of Anopheles arabiensis Patton (Diptera: Culicidae) in and Around Kassala Town, Eastern Sudan

PubMed Central

Hamza, Asma Mahmoud; El Rayah, El Amin

2016-01-01

Anopheles arabiensis Patton (Diptera: Culicidae) is considered the most efficient malaria vector in eastern Sudan. This study aims to characterize the breeding sites of An. arabiensis throughout the year in and around Kassala town, eastern Sudan. Diverse larval habitat types were visited and characterized based on the habitat type and chemical composition. Mosquito larvae were found in many diverse habitats. During the rainy season, rain pools and water bodies created by the seasonal Gash River serve as the main breeding sites. In the dry season, irrigation canals, seepage from water pipes, neglected wells, artificial containers, and man-made ditches serve as the main breeding sites. Breeding water showed a pH of 7.9 and a low concentration of the total dissolved salts. The results of this study may be considered in planning and implementing larval control programs in the area. PMID:27547039

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

Registry-linked electronic influenza vaccine provider reminders: a cluster-crossover trial.

PubMed

Stockwell, Melissa S; Catallozzi, Marina; Camargo, Stewin; Ramakrishnan, Rajasekhar; Holleran, Stephen; Findley, Sally E; Kukafka, Rita; Hofstetter, Annika M; Fernandez, Nadira; Vawdrey, David K

2015-01-01

To determine the impact of a vaccination reminder in an electronic health record supplemented with data from an immunization information system (IIS). A noninterruptive influenza vaccination reminder, based on a real-time query of hospital and city IIS, was used at 4 urban, academically affiliated clinics serving a low-income population. Using a randomized cluster-crossover design, each study site had "on" and "off" period during the fall and winter of 2011-2012. Influenza vaccination during a clinic visit was assessed for 6-month to 17-year-old patients. To assess sustainability, the reminder was active at all sites during the 2012-2013 season. In the 2011-2012 season, 8481 unique non-up-to-date children had visits. Slightly more non-up-to-date children seen when the reminder was 'on' were vaccinated than when 'off' (76.2% vs 73.8%; P = .027). Effects were seen in the winter (67.9% vs 62.2%; P = .005), not fall (76.8% vs 76.5%). The reminder also increased documentation of the reason for vaccine non-administration (68.1% vs 41.5%; P < .0001). During the 2011-2012 season, the reminder displayed for 8630 unique visits, and clinicians interacted with it in 83.1% of cases where patients required vaccination. During the 2012-2013 season, it displayed for 22 248 unique visits; clinicians interacted with it in 84.8% of cases. An IIS-linked influenza vaccination reminder increased vaccination later in the winter when fewer vaccine doses are usually given. Although the reminder did not require clinicians to interact with it, they frequently did; utilization did not wane over time. Copyright © 2015 by the American Academy of Pediatrics.

The topology and dynamics of complex networks

NASA Astrophysics Data System (ADS)

Dezso, Zoltan

We start with a brief introduction about the topological properties of real networks. Most real networks are scale-free, being characterized by a power-law degree distribution. The scale-free nature of real networks leads to unexpected properties such as the vanishing epidemic threshold. Traditional methods aiming to reduce the spreading rate of viruses cannot succeed on eradicating the epidemic on a scale-free network. We demonstrate that policies that discriminate between the nodes, curing mostly the highly connected nodes, can restore a finite epidemic threshold and potentially eradicate the virus. We find that the more biased a policy is towards the hubs, the more chance it has to bring the epidemic threshold above the virus' spreading rate. We continue by studying a large Web portal as a model system for a rapidly evolving network. We find that the visitation pattern of a news document decays as a power law, in contrast with the exponential prediction provided by simple models of site visitation. This is rooted in the inhomogeneous nature of the browsing pattern characterizing individual users: the time interval between consecutive visits by the same user to the site follows a power law distribution, in contrast with the exponential expected for Poisson processes. We show that the exponent characterizing the individual user's browsing patterns determines the power-law decay in a document's visitation. Finally, we turn our attention to biological networks and demonstrate quantitatively that protein complexes in the yeast, Saccharomyces cerevisiae, are comprised of a core in which subunits are highly coexpressed, display the same deletion phenotype (essential or non-essential) and share identical functional classification and cellular localization. The results allow us to define the deletion phenotype and cellular task of most known complexes, and to identify with high confidence the biochemical role of hundreds of proteins with yet unassigned functionality.

Integrating information about location and value of resources by white-faced saki monkeys (Pithecia pithecia).

PubMed

Cunningham, Elena; Janson, Charles

2007-07-01

Most studies of spatial memory in primates focus on species that inhabit large home ranges and have dispersed, patchy resources. Researchers assume that primates use memory to minimize distances traveled between resources. We investigated the use of spatial memory in a group of six white-faced sakis (Pithecia pithecia) on 12.8-ha Round Island, Guri Lake, Venezuela during a period of fruit abundance. The sakis' movements were analyzed with logistic regressions, a predictive computer model and a computer model that simulates movements. We considered all the resources available to the sakis and compared observed distances to predicted distances from a computer model for foragers who know nothing about the location of resources. Surprisingly, the observed distances were four times greater than the predicted distances, suggesting that the sakis passed by a majority of the available fruit trees without feeding. The odds of visiting a food tree, however, were significantly increased if the tree had been visited in the previous 3 days and had more than 100 fruit. The sakis' preferred resources were highly productive fruit trees, Capparis trees, and trees with water holes. They traveled efficiently to these sites. The sakis choice of feeding sites indicate that they combined knowledge acquired by repeatedly traveling through their home range with 'what' and 'where' information gained from individual visits to resources. Although the sakis' foraging choices increased the distance they traveled overall, choosing more valued sites allowed the group to minimize intra-group feeding competition, maintain intergroup dominance over important resources, and monitor the state of resources throughout their home range. The sakis' foraging decisions appear to have used spatial memory, elements of episodic-like memory and social and nutritional considerations.

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

PubMed

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

2016-06-01

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

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

PubMed

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

2015-04-08

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

10 CFR 171.9 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... LICENSES, INCLUDING HOLDERS OF CERTIFICATES OF COMPLIANCE, REGISTRATIONS, AND QUALITY ASSURANCE PROGRAM... example, via Electronic Information Exchange, or CD-ROM. Electronic submissions must be made in a manner... obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to...

General Healthcare Maintenance of IBD

MedlinePlus

... is helpful to determine medication-associated abnormalities and benefits. Colonoscopies: These are key in the management of ... Want to Talk? Talk to a Specialist by phone at (888) MY-GUT-PAIN by email at info@crohnscolitisfoundation.org , or ... Visit our mobile site Full Site CCF Facebook Follow The CCF ...

10 CFR 171.9 - Communications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... LICENSES, INCLUDING HOLDERS OF CERTIFICATES OF COMPLIANCE, REGISTRATIONS, AND QUALITY ASSURANCE PROGRAM... example, via Electronic Information Exchange, or CD-ROM. Electronic submissions must be made in a manner... obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to...

James Ferguson remembered

NASA Astrophysics Data System (ADS)

Davenhall, Clive

2012-03-01

The year 2010 marked the three hundredth anniversary of the birth of the astronomer, author and lecturer James Ferguson (1710-1776). Subsequently I visited the site of the churchyard where Ferguson is buried. He is mentioned in a plaque on the site and I thought that the details might be of interest.

Methods to Limit Attrition in Longitudinal Comparative Effectiveness Trials: Lessons from the Lithium Use for Bipolar Disorder (LiTMUS) Study

PubMed Central

Sylvia, Louisa G.; Reilly-Harrington, Noreen A.; Leon, Andrew C.; Kansky, Christine I.; Ketter, Terence A.; Calabrese, Joseph R.; Thase, Michael E.; Bowden, Charles L.; Friedman, Edward S.; Ostacher, Michael J.; Iosifescu, Dan V.; Severe, Joanne; Nierenberg, Andrew A.

2013-01-01

Background High attrition rates which occur frequently in longitudinal clinical trials of interventions for bipolar disorder limit the interpretation of results. Purpose The aim of this article is to present design approaches that limited attrition in the Lithium Use for Bipolar Disorder (LiTMUS) Study. Methods LiTMUS was a 6-month randomized, longitudinal multi-site comparative effectiveness trial that examined bipolar participants who were at least mildly ill. Participants were randomized to either low to moderate doses of lithium or no lithium, in addition to other treatments needed for mood stabilization administered in a guideline-informed, empirically supported, and personalized fashion (N=283). Results Components of the study design that may have contributed to the low attrition rate of the study included use of: (1) an intent-to-treat design; (2) a randomized adjunctive single-blind design; (3) participant reimbursement; (4) intent-to-attend the next study visit (includes a discussion of attendance obstacles when intention is low); (5) quality care with limited participant burden; and (6) target windows for study visits. Limitations Site differences and the effectiveness and tolerability data have not been analyzed yet. Conclusions These components of the LiTMUS study design may have reduced the probability of attrition which would inform the design of future randomized clinical effectiveness trials. PMID:22076437

[To evaluate the quality of life and peristomal skin ostomy patient with the new device Sensura].

PubMed

Crespo Fontán, Beatriz; Caparrós Sanz, María Rosario; Lainez Pardos, Pilar Lourdes; Davín Durban, Inmaculada

2010-10-01

In 2006, Coloplast launched in several European countries a new device for ostomy care called Sensura. This clinical research report includes only the results of the subpopulation included in Spain as a part of an international study involving many countries such as Denmark, United States, Canada, Australia, Poland, Netherlands, France, Slovakia, Germany, UK, Italy, Iceland, Japan, Czech Republic, Portugal, South Korea and Argentina. OBJECTIVES AND STUDY VARIABLES: The main purpose of the study is to evaluate the experience with Sensura, under normal conditions of use, with special attention to skin condition and quality of life. The main objective of the study is to evaluate the quality of life, through Quality of Life Questionnaire called "Stoma QoL". A secondary objective, is to study the correlation between quality of life and the peristomal skin condition. Other Secondary objectives include the evaluation of the patient's current device at the time of entering the study and by the other hand, the device Sensura and safety evaluation throughout the study. The study was designed as an open label non-comparative, multi-national Post Market study. The study period for each patient is 6 to 8 weeks +/- 4 days, which includes an initial visit and a final visit. The study population included people who carry a colostomy or ileostomy. Regarding Spain, a total of 10 sites participated and included a total of 131 patients. This report only presents results for nine sites and a total of 123 patients. The reason is that the last participating site began the study with a considerable delay The remaining subjects included in this site together with the other centers in Spain and the other participating countries will be included in the final international report, that will present the overall results. MEASUREMENT TOOLS. Stoma-QoL (Quality of Life Questionnaire for people with an ostomy). OST (Ostomy Skin Tool) instrument for the assessment of peristomal skin. As for the quality of life, at baseline we found a mean of 59 out of 100 (SD = 8.8), while the final study visit, mean score was 59.6 out of 100 (SD = 9.3), although the final results on this variable will be presented in the global report, since it has not reached sufficient population in Spain for the analysis of this variable. The study revealed a significant improvement in the peristomal skin condition at the end of the study, measured by the tool OST (Ostomy Skin Tool). Regarding the evaluation of the SenSura device, there was a significant improvement related to the appearance of leakage of effluent, as well as other items evaluated in relation with the device.

76 FR 6458 - Notice of Intent to File Competing License Applications, Filing of Pre-Application Documents...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-04

..., Seneca Nation of Indians, P.O. Box 231, 90 Ohi:yo' Way, Salamanca, NY 14779. i. FERC Contact: Gaylord... site visit is as follows: Date: Wednesday, February 23, 2011. Time: 1:30 p.m. to 4 p.m. Location... identify preliminary information and study needs; (4) review and discuss the process plan and schedule for...

Charter Schools in Action: What Have We Learned?

ERIC Educational Resources Information Center

Finn, Chester E., Jr.; And Others

This report contains the findings of the first year of a 2-year Hudson Institute study of U.S. charter schools, which focused on their startup problems, solutions to the problems, and the policy environments in which such schools are most likely to thrive or falter. Data during 1995-96 were derived from site visits to 35 charter schools, which…

Exploring Diversity at GCSE: Making a First World War Battlefields Visit Meaningful to All Students

ERIC Educational Resources Information Center

Philpott, Joanne; Guiney, Daniel

2011-01-01

Having already reflected on ways of improving their students' understanding of historical diversity at Key Stage 3, Joanne Philpott and Daniel Guiney set themselves the challenge of extending this to post-14 students by means of fieldwork activities at First World War battlefields sites. In addition, they wanted to link the study of past diversity…

How People Choose Vocational Education and Training Programs: Social, Education and Personal Influences on Aspiration.

ERIC Educational Resources Information Center

Maxwell, Graham; Cooper, Maureen; Biggs, Neville

The reasons why Australians choose to enroll in vocational education and training (VET) programs were examined through a questionnaire survey and site visits. The questionnaire yielded responses from 1,501 VET students of a target sample of 3,000 students who were equally representative of the following fields of study: business, engineering,…

Testing global positioning system telemetry to study wolf predation on deer fawns

USGS Publications Warehouse

Demma, D.J.; Barber-Meyer, S. M.; Mech, L.D.

2007-01-01

We conducted a pilot study to test the usefulness of Global Positioning System (GPS) collars for investigating wolf (Canis lupus) predation on white-tailed deer (Odocoileus virginianus) fawns. Using GPS collars with short location-attempt intervals on 5 wolves and 5 deer during summers 2002-2004 in northeastern Minnesota, USA, demonstrated how this approach could provide new insights into wolf hunting behavior of fawns. For example, a wolf traveled ???1.5-3.0 km and spent 20-22 hours in the immediate vicinity of known fawn kill sites and ???0.7 km and 8.3 hours at scavenging sites. Wolf travel paths indicated that wolves intentionally traveled into deer summer ranges, traveled ???0.7-4.2 km in such ranges, and spent <1-22 hours per visit. Each pair of 3 GPS-collared wolf pack members were located together for ???6% of potential locations. From GPS collar data, we estimated that each deer summer range in a pack territory containing 5 wolves ???1 year old and hunting individually would be visited by a wolf on average every 3-5 days. This approach holds great potential for investigating summer hunting behavior of wolves in areas where direct observation is impractical or impossible.

KSC-2014-2615

NASA Image and Video Library

2014-05-20

CAPE CANAVERAL, Fla. -- A crawler-transporter rolls toward Launch Pad 39A at NASA's Kennedy Space Center in Florida. Operations are underway to move Mobile Launcher Platform-2, or MLP-2, from the pad to a nearby park site in Launch Complex 39. The historic launch pad was the site from which numerous Apollo and space shuttle missions began and is beginning a new mission as a commercial launch site. NASA signed a property agreement with Space Exploration Technologies Corp., or SpaceX, of Hawthorne, California, on April 14 for use and occupancy of the seaside complex along Florida's central east coast. It will serve as a platform for SpaceX to support their commercial launch activities. For more information on Launch Pad 39A, visit http://www.nasa.gov/centers/kennedy/pdf/167416main_LC39-08.pdf. For learn more about the crawler-transporter, visit http://www.nasa.gov/centers/kennedy/pdf/167402main_crawlertransporters07.pdf. Photo credit: NASA/Kim Shiflett

KSC-2014-2622

NASA Image and Video Library

2014-05-20

CAPE CANAVERAL, Fla. -- A crawler-transporter carries Mobile Launcher Platform-2, or MLP-2, away from Launch Pad 39A at NASA's Kennedy Space Center in Florida. The MLP is being moved to a nearby park site in Launch Complex 39. The historic launch pad was the site from which numerous Apollo and space shuttle missions began and is beginning a new mission as a commercial launch site. NASA signed a property agreement with Space Exploration Technologies Corp., or SpaceX, of Hawthorne, California, on April 14 for use and occupancy of the seaside complex along Florida's central east coast. It will serve as a platform for SpaceX to support their commercial launch activities. For more information on Launch Pad 39A, visit http://www.nasa.gov/centers/kennedy/pdf/167416main_LC39-08.pdf. For learn more about the crawler-transporter, visit http://www.nasa.gov/centers/kennedy/pdf/167402main_crawlertransporters07.pdf. Photo credit: NASA/Kim Shiflett

Training the trainers: beyond providing a well-received course.

PubMed

Blitz, Julia; Edwards, Jill; Mash, Bob; Mowle, Steve

2016-09-01

The Royal College of General Practitioners in partnership with the South African Academy of Family Physicians obtained funding to run a series of 'Training the Trainers' courses for trainers of family medicine registrars, with a view to strengthening clinical supervision of postgraduate registrars. The authors wanted to establish whether it was worthwhile for the course to be provided on an ongoing basis after the funded project was completed. Development of a pilot tool for evaluation visits after a faculty development course. The authors developed a pre-visit pack and conducted five site visits to registrar trainers who had been on the course between 12 and 24 months earlier. Before the series of visits and after each visit we debriefed and modified our approach. Optimising the use of the pre-visit pack will require greater orientation of the trainer. Administrative support for the visits will be vital. The visits were experienced very positively. However, in a context in which these visits are not the norm, the trainers need support and encouragement to participate in an activity which made them feel quite vulnerable. The tool enabled course participants to show evidence of their behaviour change, enabled their colleagues to report on the impact on their own teaching practices, and enabled registrars to voice their opinions of their trainer's supervision skills. A post-course formative evaluation visit has the potential to catalyse the impact of the training course. It will be necessary to train the family physicians who conduct these visits.

Feeding the world's largest fish: highly variable whale shark residency patterns at a provisioning site in the Philippines

PubMed Central

Araujo, Gonzalo; Labaja, Jessica; McCoy, Emer; Murray, Ryan; Ponzo, Alessandro

2017-01-01

Provisioning wildlife for tourism is a controversial yet widespread practice. We analysed the residency patterns of juvenile whale sharks (Rhincodon typus) in Oslob, Philippines, where provisioning has facilitated a large shark-watching operation since 2011. We identified 208 individual sharks over three years, with an average of 18.6 (s.d. = 7.8, range = 6–43) individuals sighted per week. Weekly shark abundance varied seasonally and peak-season abundance (approx. May–November) increased across years. Whale sharks displayed diverse individual site visitation patterns ranging from a single visit to sporadic visits, seasonal residency and year-round residency. Nine individuals became year-round residents, which represents a clear response to provisioning. The timing of the seasonal peak at Oslob did not align with known non-provisioned seasonal aggregations elsewhere in the Philippines, which could suggest that seasonal residents at Oslob exploit this food source when prey availability at alternative sites is low. Since prolonged residency equates to less time foraging naturally, provisioning could influence foraging success, alter distributions and lead to dependency in later life stages. Such impacts must be carefully weighed against the benefits of provisioning (i.e. tourism revenue in a remote community) to facilitate informed management decisions. PMID:28989750

Feeding the world's largest fish: highly variable whale shark residency patterns at a provisioning site in the Philippines.

PubMed

Thomson, Jordan A; Araujo, Gonzalo; Labaja, Jessica; McCoy, Emer; Murray, Ryan; Ponzo, Alessandro

2017-09-01

Provisioning wildlife for tourism is a controversial yet widespread practice. We analysed the residency patterns of juvenile whale sharks ( Rhincodon typus ) in Oslob, Philippines, where provisioning has facilitated a large shark-watching operation since 2011. We identified 208 individual sharks over three years, with an average of 18.6 (s.d. = 7.8, range = 6-43) individuals sighted per week. Weekly shark abundance varied seasonally and peak-season abundance (approx. May-November) increased across years. Whale sharks displayed diverse individual site visitation patterns ranging from a single visit to sporadic visits, seasonal residency and year-round residency. Nine individuals became year-round residents, which represents a clear response to provisioning. The timing of the seasonal peak at Oslob did not align with known non-provisioned seasonal aggregations elsewhere in the Philippines, which could suggest that seasonal residents at Oslob exploit this food source when prey availability at alternative sites is low. Since prolonged residency equates to less time foraging naturally, provisioning could influence foraging success, alter distributions and lead to dependency in later life stages. Such impacts must be carefully weighed against the benefits of provisioning (i.e. tourism revenue in a remote community) to facilitate informed management decisions.

Where is the UK's pollinator biodiversity? The importance of urban areas for flower-visiting insects.

PubMed

Baldock, Katherine C R; Goddard, Mark A; Hicks, Damien M; Kunin, William E; Mitschunas, Nadine; Osgathorpe, Lynne M; Potts, Simon G; Robertson, Kirsty M; Scott, Anna V; Stone, Graham N; Vaughan, Ian P; Memmott, Jane

2015-03-22

Insect pollinators provide a crucial ecosystem service, but are under threat. Urban areas could be important for pollinators, though their value relative to other habitats is poorly known. We compared pollinator communities using quantified flower-visitation networks in 36 sites (each 1 km(2)) in three landscapes: urban, farmland and nature reserves. Overall, flower-visitor abundance and species richness did not differ significantly between the three landscape types. Bee abundance did not differ between landscapes, but bee species richness was higher in urban areas than farmland. Hoverfly abundance was higher in farmland and nature reserves than urban sites, but species richness did not differ significantly. While urban pollinator assemblages were more homogeneous across space than those in farmland or nature reserves, there was no significant difference in the numbers of rarer species between the three landscapes. Network-level specialization was higher in farmland than urban sites. Relative to other habitats, urban visitors foraged from a greater number of plant species (higher generality) but also visited a lower proportion of available plant species (higher specialization), both possibly driven by higher urban plant richness. Urban areas are growing, and improving their value for pollinators should be part of any national strategy to conserve and restore pollinators.

Hominid visitation of the Moravian Karst during the Middle-Upper Paleolithic transition: New results from Pod Hradem Cave (Czech Republic).

PubMed

Nejman, L; Wood, R; Wright, D; Lisá, L; Nerudová, Z; Neruda, P; Přichystal, A; Svoboda, J

2017-07-01

In 1956-1958, excavations of Pod Hradem Cave in Moravia (eastern Czech Republic) revealed evidence for human activity during the Middle-Upper Paleolithic transition. This spanned 25,050-44,800 cal BP and contained artefacts attributed to the Aurignacian and Szeletian cultures, including those made from porcelanite (rarely used at Moravian Paleolithic sites). Coarse grained excavation techniques and major inversions in radiocarbon dates meant that site chronology could not be established adequately. This paper documents re-excavation of Pod Hradem in 2011-2012. A comprehensive AMS dating program using ultrafiltration and ABOx-SC pre-treatments provides new insights into human occupation at Pod Hradem Cave. Fine-grained excavation reveals sedimentary units spanning approximately 20,000 years of the Early Upper Paleolithic and late Middle Paleolithic periods, thus making it the first archaeological cave site in the Czech Republic with such a sedimentary and archaeological record. Recent excavation confirms infrequent human visitation, including during the Early Aurignacian by people who brought with them portable art objects that have no parallel in the Czech Republic. Raw material diversity of lithics suggests long-distance imports and ephemeral visits by highly mobile populations throughout the EUP period. Copyright © 2017 Elsevier Ltd. All rights reserved.

Where is the UK's pollinator biodiversity? The importance of urban areas for flower-visiting insects

PubMed Central

Baldock, Katherine C. R.; Goddard, Mark A.; Hicks, Damien M.; Kunin, William E.; Mitschunas, Nadine; Osgathorpe, Lynne M.; Potts, Simon G.; Robertson, Kirsty M.; Scott, Anna V.; Stone, Graham N.; Vaughan, Ian P.; Memmott, Jane

2015-01-01

Insect pollinators provide a crucial ecosystem service, but are under threat. Urban areas could be important for pollinators, though their value relative to other habitats is poorly known. We compared pollinator communities using quantified flower-visitation networks in 36 sites (each 1 km2) in three landscapes: urban, farmland and nature reserves. Overall, flower-visitor abundance and species richness did not differ significantly between the three landscape types. Bee abundance did not differ between landscapes, but bee species richness was higher in urban areas than farmland. Hoverfly abundance was higher in farmland and nature reserves than urban sites, but species richness did not differ significantly. While urban pollinator assemblages were more homogeneous across space than those in farmland or nature reserves, there was no significant difference in the numbers of rarer species between the three landscapes. Network-level specialization was higher in farmland than urban sites. Relative to other habitats, urban visitors foraged from a greater number of plant species (higher generality) but also visited a lower proportion of available plant species (higher specialization), both possibly driven by higher urban plant richness. Urban areas are growing, and improving their value for pollinators should be part of any national strategy to conserve and restore pollinators. PMID:25673686

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

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).

10 CFR 52.3 - Written communications.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., for example, via Electronic Information Exchange, e-mail, or CD-ROM. Electronic submissions must be... submissions can be obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]; or by writing the Office of Information Services, U.S. Nuclear...