WorldWideScience

Sample records for underserved areas microform

  1. FHFA Underserved Areas

    Data.gov (United States)

    Department of Housing and Urban Development — Federal Housing Finance Agency's (FHFA) Underserved Areas establishes underserved area designations for census tracts in Metropolitan Areas (MSAs), nonmetropolitan...

  2. 5 CFR 894.801 - Will benefits be available in underserved areas?

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Will benefits be available in underserved... Underserved Areas § 894.801 Will benefits be available in underserved areas? (a) Dental and vision plans under FEDVIP will include underserved areas in their service areas and provide benefits to enrollees in...

  3. 77 FR 43127 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2013

    Science.gov (United States)

    2012-07-23

    ... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved... determination of the States that qualify as Medically Underserved Areas under the Federal Employees Health... law that mandates special consideration for enrollees of certain FEHB plans who receive covered health...

  4. 78 FR 50119 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2014

    Science.gov (United States)

    2013-08-16

    ... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved... determination of the states that qualify as Medically Underserved Areas under the Federal Employees Health... law that mandates special consideration for enrollees of certain FEHB plans who receive covered health...

  5. 76 FR 31998 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2012

    Science.gov (United States)

    2011-06-02

    ... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved... Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2012. This is... certain FEHB plans who receive covered health services in States with critical shortages of primary care...

  6. 75 FR 32972 - Federal Employees Health Benefits Program; Medically Underserved Areas for 2011

    Science.gov (United States)

    2010-06-10

    ... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program; Medically Underserved... Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2011. This is... certain FEHB plans who receive covered health services in States with critical shortages of primary care...

  7. Telemed: Ehealth applications applied to underserved areas in Latin America

    International Nuclear Information System (INIS)

    Sachpazidis, Ilias; Ohl, Roland; Binotto, Alecio Pedro Delazari; Torres, Marcio Soares; Messina, Luiz Ary; Sales, Alexandre; Gomes, Ricardo; Sakas, Georgios

    2006-01-01

    Access to medical care is sometimes very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Brazil. Citizens have no access to health care. They have to travel hundreds of kilometres to receive medical care. In this paper, we will propose a medical network based on state-of-the-art medical imaging application that addresses the problems of providing health care from a distance. Additionally, we are going to show preliminarily results of the first year of the system deployment and utilization in undeserved regions in Brazil. The total number of patients submitted to ultrasound examinations, during the 10 months of projects' medical trials, is 321. The exams have begun with the elderly people (hypertension and diabetes cases) with 90% above 50-years-old. Fifty-four percent were male and 46% were female. From those exams, 67 exams (21%) needed a second medical opinion and were transmitted to Santa Casa hospital in Porto Alegre, Brazil, one of the referral medical centres. From those second opinions of Santa Casa, 12 exams had to be repeated since the acquired images were not sufficient to give a correct diagnosis. The Lagoa Tres Cantos medical doctor performed also preventive exams with patients who had not presented any symptoms (70%)

  8. Telemed: Ehealth applications applied to underserved areas in Latin America

    Energy Technology Data Exchange (ETDEWEB)

    Sachpazidis, Ilias [Fraunhofer Institute for Computer Graphics, Fraunhoferstr. 5, D-64283, Darmstadt (Germany)]. E-mail: Ilias.Sachpazidis@igd.fraunhofer.de; Ohl, Roland [MedCom Gesellschaft fuer medizinische Bildverarbeitung mbH, Rundeturmstr. 12, D-64283, Darmstadt (Germany); Binotto, Alecio Pedro Delazari [Centro de Excelencia em Tecnologias Avancadas Av. Assis Brasil, 8450, 91, 140-000 Porto Alegre (Brazil); Torres, Marcio Soares [Centro de Excelencia em Tecnologias Avancadas Av. Assis Brasil, 8450, 91, 140-000 Porto Alegre (Brazil); Messina, Luiz Ary [Messina Informatica e Comercio Ltda., Rua Castelo Branco 330, 29100-040 Praia da Costa, Vila Velha (Brazil); Sales, Alexandre [Fundacao de Apoio ao Hospital Universitario da UFES-Fahucam, Av. Marechal Campos 1355, 29042-715 Santos Dumont, Vitoria (Brazil); Gomes, Ricardo [Complexo Hospitalar Santa Casa de Porto Alegre Rua Prof. Annes Dias 285, Porto Alegre (Brazil); Sakas, Georgios [Fraunhofer Institute for Computer Graphics, Fraunhoferstr. 5, D-64283, Darmstadt (Germany)

    2006-12-20

    Access to medical care is sometimes very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Brazil. Citizens have no access to health care. They have to travel hundreds of kilometres to receive medical care. In this paper, we will propose a medical network based on state-of-the-art medical imaging application that addresses the problems of providing health care from a distance. Additionally, we are going to show preliminarily results of the first year of the system deployment and utilization in undeserved regions in Brazil. The total number of patients submitted to ultrasound examinations, during the 10 months of projects' medical trials, is 321. The exams have begun with the elderly people (hypertension and diabetes cases) with 90% above 50-years-old. Fifty-four percent were male and 46% were female. From those exams, 67 exams (21%) needed a second medical opinion and were transmitted to Santa Casa hospital in Porto Alegre, Brazil, one of the referral medical centres. From those second opinions of Santa Casa, 12 exams had to be repeated since the acquired images were not sufficient to give a correct diagnosis. The Lagoa Tres Cantos medical doctor performed also preventive exams with patients who had not presented any symptoms (70%)

  9. Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?

    Science.gov (United States)

    Laraque-Arena, Danielle; Frintner, Mary Pat; Cull, William L

    2016-01-01

    To examine whether resident characteristics and experiences are related to practice in underserved areas. Cross-sectional survey of a national random sample of pediatric residents (n = 1000) and additional sample of minority residents (n = 223) who were graduating in 2009 was conducted. Using weighted logistic regression, we examined relationships between resident characteristics (background, values, residency experiences, and practice goals) and reported 1) expectation to practice in underserved area and 2) postresidency position in underserved area. Response rate was 57%. Forty-one percent of the residents reported that they had an expectation of practicing in an underserved area. Of those who had already accepted postresidency positions, 38% reported positions in underserved areas. Service obligation in exchange for loans/scholarships and primary care/academic pediatrics practice goals were the strongest predictors of expectation of practicing in underserved areas (respectively, adjusted odds ratio 4.74, 95% confidence interval 1.87-12.01; adjusted odds ratio 3.48, 95% confidence interval 1.99-6.10). Other significant predictors include hospitalist practice goals, primary care practice goals, importance of racial/ethnic diversity of patient population in residency selection, early plan (before medical school) to care for underserved families, mother with a graduate or medical degree, and higher score on the Universalism value scale. Service obligation and primary care/academic pediatrics practice goal were also the strongest predictors for taking a postresidency job in underserved area. Trainee characteristics such as service obligations, values of humanism, and desire to serve underserved populations offer the hope that policies and public funding can be directed to support physicians with these characteristics to redress the maldistribution of physicians caring for children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All

  10. Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions

    Directory of Open Access Journals (Sweden)

    Bärnighausen Till

    2009-06-01

    Full Text Available Abstract In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments; promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers; selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals; placement (programmes should match participants to areas in order to maximize participant satisfaction and

  11. Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions.

    Science.gov (United States)

    Bärnighausen, Till; Bloom, David E

    2009-06-26

    In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes

  12. Continuing interprofessional education in geriatrics and gerontology in medically underserved areas.

    Science.gov (United States)

    Toner, John A; Ferguson, K Della; Sokal, Regina Davis

    2009-01-01

    There is a widening gap between the health care needs of older persons and the treatment skills of the health care professionals who serve them. This gap is especially severe in rural areas, where there is a shortage of and inadequate collaboration between health care professionals and poor access to services for older persons. There is also a special opportunity in rural areas, particularly those designated as "medically underserved," for continuing interprofessional education as a vehicle for retaining health care professionals who tend to leave medically underserved areas for more lucrative professional opportunities elsewhere. In collaboration with the Consortium of New York Geriatric Education Centers, the Columbia-New York Geriatric Education Center at the Stroud Center of Columbia University has developed the Program for Outreach to Interprofessional Services and Education (POISE). The purpose of POISE is to develop, implement, evaluate, and sustain interprofessional education and training for health care learners, while emphasizing improved access to health services for the geriatric population in medically underserved areas. The POISE model was designed as an effective approach to teaching the core geriatrics and gerontology curriculum endorsed by the national (U.S. Department of Health and Human Services) network of Geriatric Education Centers to health care learners in medically underserved areas of upstate New York. This article describes the adaptation and implementation of the POISE model.

  13. Increasing access to health workers in underserved areas: a conceptual framework for measuring results

    NARCIS (Netherlands)

    Huicho, L.; Dieleman, M.; Campbell, J.; Codjia, L.; Balabanova, D.; Dussault, G.; Dolea, C.

    2010-01-01

    Many countries have developed strategies to attract and retain qualified health workers in underserved areas, but there is only scarce and weak evidence on their successes or failures. It is difficult to compare lessons and measure results from the few evaluations that are available. Evaluation

  14. Increasing access to health workers in underserved areas : a conceptual framework for measuring results

    NARCIS (Netherlands)

    Huicho, Luis; Dieleman, Marjolein; Campbell, James; Codjia, Laurence; Balabanova, Dina; Dussault, Gilles; Dolea, Carmen

    Many countries have developed strategies to attract and retain qualified health workers in underserved areas, but there is only scarce and weak evidence on their successes or failures. It is difficult to compare lessons and measure results from the few evaluations that are available. Evaluation

  15. Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas.

    Science.gov (United States)

    Barclift, Songhai C; Brown, Elizabeth J; Finnegan, Sean C; Cohen, Elena R; Klink, Kathleen

    2016-05-01

    Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program. Methods Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)-funded training positions. Results More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas. Conclusions The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014-2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities.

  16. A national study on nurses' retention in healthcare facilities in underserved areas in Lebanon.

    Science.gov (United States)

    El-Jardali, Fadi; Alameddine, Mohamad; Jamal, Diana; Dimassi, Hani; Dumit, Nuhad Y; McEwen, Mary K; Jaafar, Maha; Murray, Susan F

    2013-09-30

    Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon. This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student's t-test and ANOVA) tests to describe the respondents and examine the significance between nurses' characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses' intent to stay in underserved areas. A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P job satisfaction and their intent to stay. This study reveals poor retention of nurses in rural and underserved

  17. Financial incentives for return of service in underserved areas: a systematic review

    Directory of Open Access Journals (Sweden)

    Bärnighausen Till

    2009-05-01

    Full Text Available Abstract Background In many geographic regions, both in developing and in developed countries, the number of health workers is insufficient to achieve population health goals. Financial incentives for return of service are intended to alleviate health worker shortages: A (future health worker enters into a contract to work for a number of years in an underserved area in exchange for a financial pay-off. Methods We carried out systematic literature searches of PubMed, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, and the National Health Services Economic Evaluation Database for studies evaluating outcomes of financial-incentive programs published up to February 2009. To identify articles for review, we combined three search themes (health workers or students, underserved areas, and financial incentives. In the initial search, we identified 10,495 unique articles, 10,302 of which were excluded based on their titles or abstracts. We conducted full-text reviews of the remaining 193 articles and of 26 additional articles identified in reference lists or by colleagues. Forty-three articles were included in the final review. We extracted from these articles information on the financial-incentive programs (name, location, period of operation, objectives, target groups, definition of underserved area, financial incentives and obligation and information on the individual studies (authors, publication dates, types of study outcomes, study design, sample criteria and sample size, data sources, outcome measures and study findings, conclusions, and methodological limitations. We reviewed program results (descriptions of recruitment, retention, and participant satisfaction, program effects (effectiveness in influencing health workers to provide care, to remain, and to be satisfied with work and personal life in underserved areas, and program impacts (effectiveness in influencing health systems and health outcomes

  18. Workplace physical violence among hospital nurses and physicians in underserved areas in Jordan.

    Science.gov (United States)

    AbuAlRub, Raeda Fawzi; Al Khawaldeh, Abdullah Talal

    2014-07-01

    To: (1) examine the incidence, frequency and contributing factors to workplace violence among nurses and physicians in underserved areas in Jordan, and (2) identify the existing policies and the management modalities to tackle workplace violence. Workplace violence is a major problem in healthcare organisations. An understanding of the nature of violence is essential to implementing successful management. A descriptive exploratory research design. The questionnaire that was developed in 2003 by the International Labor Office, the International Council of Nurses, the World Health Organization, and the Public Services International was used to collect data from a convenience sample of 521 Jordanian physicians and nurses (396 nurses, 125 physicians) who worked in hospitals located in underserved areas. Around 15% of the participants were exposed to physical violence. The factors that contributed to workplace violence were related to absence of policies, inadequate staffing and lack of communication skills. Only 16·9% of participants indicated that there were specific policies available for dealing with physical workplace violence. Strengthening security and providing training were some of the important factors indicated by participants for decreasing violence in the workplace. Workplace violence is a problem in underserved areas that needs attention from administrators. Most participants were very dissatisfied with the way the administrators dealt with the incidents. Instituting firm policies against perpetrators and developing protective violence guidelines to support healthcare staff in managing workplace violence are paramount to tackle the problem of workplace violence. © 2013 John Wiley & Sons Ltd.

  19. The challenges of working in underserved areas: a qualitative exploratory study of views of policy makers and professionals.

    Science.gov (United States)

    AbuAlRub, Raeda F; El-Jardali, Fadi; Jamal, Diana; Iblasi, Abdulkareem S; Murray, Susan F

    2013-01-01

    The inadequate number of health care providers, particularly nurses, in underserved areas is one of the biggest challenges for health policymakers. There is a scarcity of research in Jordan about factors that affect nurse staffing and retention in underserved areas. To elucidate the views of staff nurses working in underserved areas, directors of health facilities in underserved areas and key informants from the policy and education arena on issues of staffing and retention of nurses in underserved areas. An exploratory study using a qualitative approach with semi-structured interviews was utilized to elucidate the views of 22 key informants from the policy and education arena, 11 directors of health centers, and 19 staff nurses on issues that contribute to low staffing and retention of nurses in underserved areas. The five stage 'framework approach' proposed by Bryman et al. (1993) was utilized for data analysis. Nursing shortage in underserved areas in Jordan are exacerbated by a lack of financial incentives, poor transportation and remoteness of these areas, bad working conditions, and lack of health education institutions in these areas, as well as by opportunities for internal and external migration. Young Jordanian male nurses usually grab any opportunity to migrate and work outside the country to improve their financial conditions; whereas, female nurses are more restricted and not encouraged to travel abroad to work. Several strategies are suggested to enhance retention in these areas, such as promoting financial incentives for staff to work there, enhancing the transportation system, and promoting continuous and academic education. Nurses' administrators and health care policy makers could utilize the findings of the present study to design and implement comprehensive interventions to enhance retention of staff in underserved areas. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Clinical medical education in rural and underserved areas and eventual practice outcomes: A systematic review and meta-analysis.

    Science.gov (United States)

    Raymond Guilbault, Ryan William; Vinson, Joseph Alexander

    2017-01-01

    Undergraduate medical students are enrolled in clinical education programs in rural and underserved urban areas to increase the likelihood that they will eventually practice in those areas and train in a primary care specialty to best serve those patient populations. MEDLINE and Cochrane Library online databases were searched to identify articles that provide a detailed description of the exposure and outcome of interest. A qualitative review of articles reporting outcome data without comparison or control groups was completed using the Medical Education Research Study Quality Instrument (MERSQI). A meta-analysis of articles reporting outcome data with comparison or control groups was completed with statistical and graphical summary estimates. Seven hundred and nine articles were retrieved from the initial search and reviewed based on inclusion and exclusion criteria. Of those, ten articles were identified for qualitative analysis and five articles included control groups and thus were included in the quantitative analysis. Results indicated that medical students with clinical training in underserved areas are almost three times as likely to practice in underserved areas than students who do not train in those areas (relative risk [RR] = 2.94; 95% confidence interval [CI]: 2.17, 4.00). Furthermore, medical students training in underserved areas are about four times as likely to practice primary care in underserved areas than students who do not train in those locations (RR = 4.35; 95% CI: 1.56, 12.10). These estimates may help guide medical school administrators and policymakers to expand underserved clinical training programs to help relieve some of the problems associated with access to medical care among underserved populations.

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

    Science.gov (United States)

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

    2018-06-01

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

  2. 36 CFR 1238.20 - How must microform records be stored?

    Science.gov (United States)

    2010-07-01

    ... relative humidity of the storage area must be a constant 35 percent RH, plus or minus 5 percent. Non-silver copies of microforms must be maintained in a different storage area than are silver gelatin originals or...

  3. Research Sources and Microforms in Black Studies: An Annotated Bibliography.

    Science.gov (United States)

    Ridinger, Robert B. Marks

    1985-01-01

    Analyzes 93 reference works and 23 microform collections concerning the Black American experience in 13 subject areas of the social sciences (anthropology, biography, race relations and civil rights, the Black church, communication studies, economics, education, dance, genealogy, Black history, sports, women's studies, and literature and language)…

  4. T@lemed: Ehealth applications applied to underserved areas in Latin America

    Science.gov (United States)

    Sachpazidis, Ilias; Ohl, Roland; Binotto, Alécio Pedro Delazari; Torres, Márcio Soares; Messina, Luiz Ary; Sales, Alexandre; Gomes, Ricardo; Sakas, Georgios

    2006-12-01

    Access to medical care is sometimes very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Brazil. Citizens have no access to health care. They have to travel hundreds of kilometres to receive medical care. In this paper, we will propose a medical network based on state-of-the-art medical imaging application that addresses the problems of providing health care from a distance. Additionally, we are going to show preliminarily results of the first year of the system deployment and utilization in undeserved regions in Brazil. The total number of patients submitted to ultrasound examinations, during the 10 months of projects' medical trials, is 321. The exams have begun with the elderly people (hypertension and diabetes cases) with 90% above 50-years-old. Fifty-four percent were male and 46% were female. From those exams, 67 exams (21%) needed a second medical opinion and were transmitted to Santa Casa hospital in Porto Alegre, Brazil, one of the referral medical centres. From those second opinions of Santa Casa, 12 exams had to be repeated since the acquired images were not sufficient to give a correct diagnosis. The Lagoa Tres Cantos medical doctor performed also preventive exams with patients who had not presented any symptoms (70%).

  5. An early stage evaluation of the Supporting Program for Obstetric Care Underserved Areas in Korea.

    Science.gov (United States)

    Na, Baeg Ju; Kim, Hyun Joo; Lee, Jin Yong

    2014-06-01

    "The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital's facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.

  6. Understanding the performance of community health volunteers involved in the delivery of health programmes in underserved areas: a realist synthesis

    OpenAIRE

    Vareilles, Ga?lle; Pommier, Jeanine; Marchal, Bruno; Kane, Sumit

    2017-01-01

    Background The recruitment of community health volunteers (CHVs) to support the delivery of health programmes is an established approach in underserved areas and in particular where there are health inequalities due to the scarcity of trained human resources. However, there is a dearth of evidence about what works to improve CHVs? performance. This review aimed to synthesise existing literature to explain why, how and under which circumstances intervention approaches to improve the performanc...

  7. Educational and individual factors associated with positive change in and reaffirmation of medical students' intention to practice in underserved areas.

    Science.gov (United States)

    Boscardin, Christy K; Grbic, Douglas; Grumbach, Kevin; O'Sullivan, Patricia

    2014-11-01

    The projected U.S. physician shortage will disproportionately affect underserved areas. This study examined the impact of medical school educational experiences on positive changes in and reaffirmation of students' intention to practice in underserved areas (practice intention). Medical students (n = 7,361) from 113 U.S. MD-granting medical schools who graduated in 2009-2010 and responded to both the Association of American Medical Colleges' 2006 Matriculating Student Questionnaire and 2010 Graduation Questionnaire were included. Multilevel logistic regression analyses were conducted to determine factors associated with change in and reaffirmation of practice intention. After controlling for individual characteristics, community health field experience (adjusted odds ratio [OR]: 1.36; 95% CI: 1.18, 1.57), learning another language (OR: 1.41; 95% CI: 1.22, 1.63), cultural competence/awareness experience (OR: 1.38; 95% CI: 1.21, 1.58), becoming more aware of perspectives of individuals from different backgrounds (OR: 1.24; 95% CI: 1.04, 1.48), and attending schools with higher social mission scores (OR: 1.66; 95% CI: 1.28, 2.16) were all significantly associated with positive changes in practice intention from matriculation to graduation. Field experience in community health (OR: 1.24; 95% CI: 0.99, 1.53), learning another language (OR: 1.29; 95% CI: 1.01, 1.65), and attending schools with higher social mission scores (OR: 1.62; 95% CI: 1.09, 2.43) were all significantly associated with reaffirmation of practice intention at graduation. Multifaceted factors are associated with practice intention. This study suggests medical schools can play active roles in alleviating the physician shortage in underserved areas through targeted curricular interventions and recruitment.

  8. The prevalence of visual impairment and blindness in underserved rural areas: a crucial issue for future.

    Science.gov (United States)

    Hashemi, H; Yekta, A; Jafarzadehpur, E; Doostdar, A; Ostadimoghaddam, H; Khabazkhoob, M

    2017-08-01

    PurposeTo determine the prevalence of visual impairment and blindness in underserved Iranian villages and to identify the most common cause of visual impairment and blindness.Patients and methodsMultistage cluster sampling was used to select the participants who were then invited to undergo complete examinations. Optometric examinations including visual acuity, and refraction were performed for all individuals. Ophthalmic examinations included slit-lamp biomicroscopy and ophthalmoscopy. Visual impairment was determined according to the definitions of the WHO and presenting vision.ResultsOf 3851 selected individuals, 3314 (86.5%) participated in the study. After using the exclusion criteria, the present report was prepared based on the data of 3095 participants. The mean age of the participants was 37.6±20.7 years (3-93 years). The prevalence of visual impairment and blindness was 6.43% (95% confidence interval (CI): 3.71-9.14) and 1.18% (95% CI: 0.56-1.79), respectively. The prevalence of visual impairment varied from 0.75% in participants aged less than 5 years to 38.36% in individuals above the age of 70 years. Uncorrected refractive errors and cataract were the first and second leading causes of visual impairment; moreover, cataract and refractive errors were responsible for 35.90 and 20.51% of the cases of blindness, respectively.ConclusionThe prevalence of visual impairment was markedly high in this study. Lack of access to health services was the main reason for the high prevalence of visual impairment in this study. Cataract and refractive errors are responsible for 80% of visual impairments which can be due to poverty in underserved villages.

  9. Development of microforming process combined with thin film transfer printing

    Directory of Open Access Journals (Sweden)

    Koshimizu Kazushi

    2015-01-01

    Full Text Available Microforming receives a lot of attentions in the recent years due to the increased use of microparts in electronics and medical sectors. For the further functionalization of these micro devices, high functional surface with noble metals are strongly required for the devices in bio- and medical fields, such as bio-sensors. To realize the submillimeter structure of metal foils and micro to nanometer structures in one forming process, the present study proposes a combined process of microforming for metal foils and transfer printing of gold (Au thin films. To clarify the availability of the proposed combined process, transferability of Au thin films under micro bulging deformation are investigated. 0.1 mm-thick pure titanium (Ti foils and 100 nm-thick Au films were used as blank and functional materials, respectively. The forming tests of the proposed process were conducted. With increasing strain of Ti foils, Au TP areas increase. By this experiment, it’s confirmed that the hydrogen reduction of oxidation layers and the strain of Ti foil are significant factor for Au TP on Ti foils.

  10. Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

    Science.gov (United States)

    Metz, Anneke M

    2017-01-01

    Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U.S. physician diversity and practice within underserved communities. MEDPREP recruits disadvantaged and underrepresented in medicine students to complete a 2-year academic enhancement program that includes science coursework, standardized test preparation, study/time management training, and emphasis on professional development. Five hundred twenty-five disadvantaged or underrepresented students over 15 years completed MEDPREP and were tracked through entry into medical practice. MEDPREP accepts up to 36 students per year, with two thirds coming from the Midwest region and another 20% from nearby states in the South. Students complete science, test preparation, academic enhancement, and professionalism coursework taught predominantly by MEDPREP faculty on the Southern Illinois University Carbondale campus. Students apply broadly to medical schools in the region and nation but are also offered direct entry into our School of Medicine upon meeting articulation program requirements. Seventy-nine percent of students completing MEDPREP became practicing physicians. Fifty-eight percent attended public medical schools, and 62% attended medical schools in the Midwest. Fifty-three percent of program alumni chose primary care specialties compared to 34% of U.S. physicians, and MEDPREP alumni were 2.7 times more likely to work in medically underserved areas than physicians nationally. MEDPREP increases the number of disadvantaged and underrepresented students entering and graduating

  11. Practical Microform Materials for Libraries: Silver, Diazo, Vesicular.

    Science.gov (United States)

    Veaner, Allen B.

    1982-01-01

    Remarks on the relative permanence and durability of three types of film in use in library microform reproduction (silver, diazo, and vesicular) and points out some technical and economic facts that govern the choice of microform materials for libraries. A 6-item reference list is included. (Author/JL)

  12. Five Decades of Microforms at the Library of Congress.

    Science.gov (United States)

    Sullivan, Robert C.

    1988-01-01

    Discusses the history of the microform collections at the Library of Congress (LC), highlighting the exchange of microfilmed newspapers between LC and the Biblioteca Nacional, Brazil. Recent developments in preservation microfilming, LC's acquisition of microforms, and the activities of the LC Preservation Microfilming Office are described. (3…

  13. 7 CFR Exhibit C to Subpart L of... - Housing in Underserved Areas

    Science.gov (United States)

    2010-01-01

    ... metropolitan statistical area that has a population exceeding 1 million; 3. Is designated by the State or... percent or more of their population at, or below, poverty level and 13 percent or more of their occupied... concentrations of poverty and substandard housing and have severe, unmet rural housing needs. B. To provide for...

  14. Factors affecting willingness to practice medicine in underserved areas: a survey of Argentine medical students.

    Science.gov (United States)

    Borracci, Raul A; Arribalzaga, Eduardo B; Couto, Juan L; Dvorkin, Mario; Ahuad Guerrero, Rodolfo A; Fernandez, Carmen; Ferreira, Luis N; Cerezo, Leticia

    2015-01-01

    Previous research has explored the effect of motivations, incentives and working conditions on willingness to accept jobs in rural and remote areas. These studies demonstrated that difficult working conditions, low job satisfaction and remuneration, and poor security, predisposed new medical graduates to select cities instead of rural districts. Since Argentina has a critical shortage of health staff in rural and low-income marginal suburban settings, and limited qualitative and quantitative local research has been done to address this issue, the present study was developed to assess the factors associated with the willingness of medical students to work in low-resource underprivileged areas of the country after graduation. A cross-sectional descriptive design was used with data collected from a self-administered questionnaire and using quantitative analysis methods. A total of 400 eligible second-year medical students were invited to participate in a survey focused on sociodemographic characteristics, incentives and working conditions expected in deprived areas, extrinsic and intrinsic motivations, university medical education and government promotion policies. Twenty-one per cent of medical students showed a strong willingness to work in a deprived area, 57.3% manifested weak willingness and 21.5% unwillingness to work in a low-resource setting. Being female, of older age, not having a university-trained professional parent, previous exposure or service in a poor area, choice of pediatrics as a specialty and strong altruistic motivations were highly associated with the willingness to practice medicine in rural or underprivileged areas. Only 21.5% of respondents considered that medical schools encourage the practice of medicine in poor deprived regions. Likewise, only 6.2% of students considered that national public health authorities suitably stimulate physician distribution in poorer districts. One-third of students expressed high altruistic motivations and

  15. Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model.

    Directory of Open Access Journals (Sweden)

    Angelo S Nyamtema

    Full Text Available In Tanzania, maternal mortality ratio (MMR, unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC services in underserved rural areas using associate clinicians.Ten health centres (HCs were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians, and forty-four nurse-midwives and clinical officers (associate clinicians were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals.After launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03 in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively. Of all deaths (maternal and IVEND 84% to 96% were considered avoidable.These findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEmONC services and to improve

  16. Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model.

    Science.gov (United States)

    Nyamtema, Angelo S; Mwakatundu, Nguke; Dominico, Sunday; Mohamed, Hamed; Pemba, Senga; Rumanyika, Richard; Kairuki, Clementina; Kassiga, Irene; Shayo, Allan; Issa, Omary; Nzabuhakwa, Calist; Lyimo, Chagi; van Roosmalen, Jos

    2016-01-01

    In Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians. Ten health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians), and forty-four nurse-midwives and clinical officers (associate clinicians) were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals. After launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03) in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS) were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND) in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively). Of all deaths (maternal and IVEND) 84% to 96% were considered avoidable. These findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEmONC services and to improve maternal and

  17. Spatial Accessibility to Health Care Services: Identifying under-Serviced Neighbourhoods in Canadian Urban Areas.

    Directory of Open Access Journals (Sweden)

    Tayyab Ikram Shah

    Full Text Available Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods.This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population, was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons. An integrated geocoding approach was used to establish PHC locations.The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs.The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood

  18. 36 CFR 1238.26 - What are the restrictions on use for permanent and unscheduled microform records?

    Science.gov (United States)

    2010-07-01

    ... permanent and unscheduled microform records? (a) Agencies must not use the silver gelatin master microform or duplicate silver gelatin microform of permanent or unscheduled records created in accordance with...

  19. Microform Market Place 1974/1975. An International Directory of Micropublishing.

    Science.gov (United States)

    Veaner, Allen B., Ed.; Meckler, Alan M., Ed.

    The information for this international buyer's guide for the microform purchaser was gathered from questionnaires to the publishers themselves. The guide is divided into eight sections: directory of micropublishers, mergers and acquisitions, bibliography of first sources for the microform library, microform jobbers, organizations, a geographical…

  20. Measurement of material mechanical properties in microforming

    Science.gov (United States)

    Yun, Wang; Xu, Zhenying; Hui, Huang; Zhou, Jianzhong

    2006-02-01

    As the rapid market need of micro-electro-mechanical systems engineering gives it the wide development and application ranging from mobile phones to medical apparatus, the need of metal micro-parts is increasing gradually. Microforming technology challenges the plastic processing technology. The findings have shown that if the grain size of the specimen remains constant, the flow stress changes with the increasing miniaturization, and also the necking elongation and the uniform elongation etc. It is impossible to get the specimen material properties in conventional tensile test machine, especially in the high precision demand. Therefore, one new measurement method for getting the specimen material-mechanical property with high precision is initiated. With this method, coupled with the high speed of Charge Coupled Device (CCD) camera and high precision of Coordinate Measuring Machine (CMM), the elongation and tensile strain in the gauge length are obtained. The elongation, yield stress and other mechanical properties can be calculated from the relationship between the images and CCD camera movement. This measuring method can be extended into other experiments, such as the alignment of the tool and specimen, micro-drawing process.

  1. Healthcare provider perceptions of the role of interprofessional care in access to and outcomes of primary care in an underserved area.

    Science.gov (United States)

    Wan, Shaowei; Teichman, Peter G; Latif, David; Boyd, Jennifer; Gupta, Rahul

    2018-03-01

    To meet the needs of an aging population who often have multiple chronic conditions, interprofessional care is increasingly adopted by patient-centred medical homes and Accountable Care Organisations to improve patient care coordination and decrease costs in the United States, especially in underserved areas with primary care workforce shortages. In this cross-sectional survey across multiple clinical settings in an underserved area, healthcare providers perceived overall outcomes associated with interprofessional care teams as positive. This included healthcare providers' beliefs that interprofessional care teams improved patient outcomes, increased clinic efficiency, and enhanced care coordination and patient follow-up. Teams with primary care physician available each day were perceived as better able to coordinate care and follow up with patients (p = .031), while teams that included clinical pharmacists were perceived as preventing medication-associated problems (p care model as a useful strategy to improve various outcomes across different clinical settings in the context of a shortage of primary care physicians.

  2. Implementing a Healthy Food Distribution Program: A Supply Chain Strategy to Increase Fruit and Vegetable Access in Underserved Areas.

    Science.gov (United States)

    DeFosset, Amelia R; Kwan, Allison; Rizik-Baer, Daniel; Gutierrez, Luis; Gase, Lauren N; Kuo, Tony

    2018-05-24

    Increasing access to fresh produce in small retail venues could improve the diet of people in underserved communities. However, small retailers face barriers to stocking fresh produce. In 2014, an innovative distribution program, Community Markets Purchasing Real and Affordable Foods (COMPRA), was launched in Los Angeles with the aim of making it more convenient and profitable for small retailers to stock fresh produce. Our case study describes the key processes and lessons learned in the first 2 years of implementing COMPRA. Considerable investments in staff capacity and infrastructure were needed to launch COMPRA. Early successes included significant week-to-week increases in the volume of produce distributed. Leveraging partnerships, maintaining a flexible operational and funding structure, and broadly addressing store owners' needs contributed to initial gains. We describe key challenges and next steps to scaling the program. Lessons learned from implementing COMPRA could inform other jurisdictions considering supply-side approaches to increase access to healthy food.

  3. "We can see a future here": Place attachment, professional identity, and forms of capital mobilized to deliver medical education in an underserviced area.

    Science.gov (United States)

    Hanlon, Neil; Halseth, Greg; Snadden, David

    2010-09-01

    Community-integrated undergraduate medical education is becoming a more common option for students predisposed to practice in rural and small town places. One such initiative, the Northern Medical Program, has been operating since 2004 in the northern interior of British Columbia, Canada. The NMP's curriculum relies heavily on the involvement of practicing physicians in its host community, Prince George. Drawing on Bourdieu's conceptualization of capital in its different forms, the commitment of the local physician community is understood as social capital derived from cultural capital centred on a collective sense of professional identity forged by conditions of practice in an underserviced area. The findings of this study are discussed with respect to the long-term operation and success of community-integrated medical education programs. Copyright 2010 Elsevier Ltd. All rights reserved.

  4. Precommitting to Serve the Underserved

    Science.gov (United States)

    Eyal, Nir; Bärnighausen, Till

    2014-01-01

    In many countries worldwide, especially in Sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas. PMID:22548519

  5. Precommitting to serve the underserved.

    Science.gov (United States)

    Eyal, Nir; Bärnighausen, Till

    2012-01-01

    In many countries worldwide, especially in sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas.

  6. Retaining health workforce in rural and underserved areas of India: What works and what doesn't? A critical interpretative synthesis.

    Science.gov (United States)

    Goel, Sonu; Angeli, Federica; Bhatnagar, Nidhi; Singla, Neetu; Grover, Manoj; Maarse, Hans

    2016-01-01

    Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8%), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas. We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low- and middle-income countries. Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban-rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions-are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas. A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence- based strategies are needed to ensure context-specific, field- tested and cost

  7. Impact of a Plant-Based Diet and Support on Mitigating Type 2 Diabetes Mellitus in Latinos Living in Medically Underserved Areas.

    Science.gov (United States)

    Ramal, Edelweiss; Champlin, Andrea; Bahjri, Khaled

    2018-03-01

    To determine the impact that a high-fiber, low-fat diet, derived from mostly plant-based sources, when coupled with support has upon self-management of type 2 diabetes mellitus in Latinos from medically underserved areas (MUAs). Experimental randomized controlled community pilot study. Three community clinics in MUAs located within San Bernardino County, California. Thirty-two randomly assigned Latinos with A1 C greater than 6.4: 15 control and 17 experimental. Participants completed a 5-week education program. Researchers provided follow-up support for 17 randomly assigned experimental group participants through focus groups held at participating clinics-1, 3, and 6 months posteducation. Changes in fat and fiber consumption were measured using a modified Dietary Screener for Mexican Americans. Self-management was measured through the Self-Efficacy for Exercise Scale and Diabetes Quality of Life Measure. Baseline characteristics for both groups were analyzed using independent t tests and χ 2 tests. A 2-way repeated-measures analysis of variance was used to analyze biometric data between baseline and 6 months for both groups. Mean A1 C levels decreased from baseline to 6 months for both groups: control, μ 1 = 9.57, μ 2 = 9.49; experimental, μ 1 = 8.53, μ 2 = 7.31. The experimental group demonstrated a statistically significant reduction in mean A1 C levels ( P = .002) when compared to the control group.

  8. 36 CFR 1238.30 - What must agencies do when transferring permanent microform records to the National Archives of...

    Science.gov (United States)

    2010-07-01

    ... specified in § 1232.14(c) of this subchapter. (c) Transfer the silver gelatin original (or duplicate silver gelatin microform created in accordance with § 1238.14) plus one microform copy. (d) Ensure that the... separately from the silver gelatin original or silver duplicate microform copy and clearly label them as non...

  9. Providing Specialty Care for the Poor and Underserved at Student-Run Free Clinics in the San Francisco Bay Area.

    Science.gov (United States)

    Liu, Max Bolun; Xiong, Grace; Boggiano, Victoria Lynn; Ye, Patrick Peiyong; Lin, Steven

    2017-01-01

    This report describes the model of specialty clinics implemented at Stanford University's two student-run free clinics, Arbor Free Clinic and Pacific Free Clinic, in the San Francisco Bay Area. We describe our patient demographic characteristics and the specialty services provided. We discuss challenges in implementing specialty care at student-run free clinics.

  10. Micro-scaled products development via microforming deformation behaviours, processes, tooling and its realization

    CERN Document Server

    Fu, Ming Wang

    2014-01-01

    ‘Micro-scaled Products Development via Microforming’ presents state-of-the-art research on microforming processes, and focuses on the development of micro-scaled metallic parts via microforming processes. Microforming refers to the fabrication of microparts via micro-scaled plastic deformation and  presents a promising micromanufacturing process. When compared to other  micromanufacturing processes, microforming offers advantages such as high productivity and good mechanical properties of the deformed microparts. This book provides extensive and informative illustrations, tables and photos in order to convey this information clearly and directly to readers. Although the knowledge of macroforming processes is abundant and widely used in industry, microparts cannot be developed by leveraging existing knowledge of macroforming because the size effect presents a barrier to this knowledge transfer. Therefore systematic knowledge of microforming needs to be developed. In tandem with product miniaturization, t...

  11. Potential use of mobile phones in improving animal health service delivery in underserved rural areas: experience from Kilosa and Gairo districts in Tanzania.

    Science.gov (United States)

    Karimuribo, Esron D; Batamuzi, Emmanuel K; Massawe, Lucas B; Silayo, Richard S; Mgongo, Frederick O K; Kimbita, Elikira; Wambura, Raphael M

    2016-10-07

    Sub-optimal performance of the animal health delivery system in rural areas is common in developing countries including Tanzania. However, penetration of mobile phones and availability of good road network and public transport systems offer opportunities for improving the access of rural communities to diagnostic and advisory services from facilities and expertise located in urban areas. A questionnaire survey on possession and use of mobile phones by pastoral and agro-pastoral communities in Kilosa and Gairo districts was carried out between November and December 2015. A total number of 138 livestock keepers from three villages of Chakwale (54), Mvumi (41) and Parakuyo (43) participated in the study. An e-based system was designed and tested to link rural communities with urban diagnostic facilities. It was observed that the average number of phones possessed by individuals interviewed and household families was 1.1 ± 0.26 (1-2) and 3.5 ± 2.23 (1-10), respectively. It was further observed that out of 138 livestock keepers interviewed, 133 (96.4 %) had feature phones while 10 (7.2 %) of them possessed smartphones. Mobile phone is currently used to support livestock production by communicating on animal health in Parakuyo (18, 41.9 %), Mvumi (18, 43.9 %) and Chakwale (14, 25.9 %). Other contributions of mobile phones in livestock and crop agriculture observed in the study area include: exchange of livestock price information, crop price information, communicating on plant health/diseases, livestock extension and advisory services as well as crop farming extension and advisory services. We also designed and tested an e-based SUAVetDiag® system to support timely diagnosis of infectious disease conditions and prompt advice on case management in veterinary underserved areas. Availability of mobile phones in rural areas, in combination with supporting infrastructure and facilities in urban areas, has potential to stimulate local development and improving

  12. Integrated model of primary and secondary eye care for underserved rural areas: The L V Prasad Eye Institute experience

    Directory of Open Access Journals (Sweden)

    Gullapalli N Rao

    2012-01-01

    Full Text Available Blindness is a major global public health problem and recent estimates from World Health Organization (WHO showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP. It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.

  13. Assessing predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan: results of a cross-sectional baseline survey.

    Science.gov (United States)

    Azmat, Syed Khurram; Ali, Moazzam; Ishaque, Muhammad; Mustafa, Ghulam; Hameed, Waqas; Khan, Omar Farooq; Abbas, Ghazunfer; Temmerman, Marleen; Munroe, Erik

    2015-03-28

    Although Pakistan was one of the first countries in Asia to launch national family planning programs, current modern contraceptive use stands at only 26% with a method mix skewed toward short-acting and permanent methods. As part of a multiyear operational research study, a baseline survey was conducted to understand the predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan. This paper presents the baseline survey results; the outcomes of the intervention will be presented in a separate paper after the study has been completed. A cross-sectional baseline household survey was conducted with randomly selected 3,998 married women of reproductive age (MWRA) in the Chakwal, Mianwali, and Bhakkar districts of Punjab. The data were analyzed on SPSS 17.0 using simple descriptive and logistic regression. Most of the women had low socio-economic status and were younger than 30 years of age. Four-fifths of the women consulted private sector health facilities for reproductive health services; proximity, availability of services, and good reputation of the provider were the main predicators for choosing the facilities. Husbands were reported as the key decision maker regarding health-seeking and family planning uptake. Overall, the current contraceptive use ranged from 17% to 21% across the districts: condoms and female sterilization were widely used methods. Woman's age, husband's education, wealth quintiles, spousal communication, location of last delivery, and favorable attitude toward contraception have an association with current contraceptive use. Unmet need for contraception was 40.6%, 36.6%, and 31.9% in Chakwal, Mianwali, and Bhakkar, respectively. Notably, more than one fifth of the women across the districts expressed willingness to use quality, affordable long-term family planning services in the future. The baseline results highlight the need for quality, affordable long-term family planning

  14. Review on progressive microforming of bulk metal parts directly using sheet metals (Keynote Paper

    Directory of Open Access Journals (Sweden)

    Fu M.W.

    2015-01-01

    Full Text Available Due to the ubiquitous trend of product miniaturization, energy saving and weight reduction, micro/meso-scale parts have been widely used in many industrial clusters. Micromanufacturing processes for production of such micro/meso-scale parts are thus critically needed. Microforming, as one of these micro manufacturing processes, is a promising process and thus got many explorations and researches. Compared with the research on size effect affected deformation behaviours, less attention has been paid to the process development for mass production of micro-parts. The product quality and fabrication productivity of micro-parts depend on the involved process chain. To address the difficulty in handling and transporting of the micro-sized workpiece, development of a progressive microforming process for directly fabricating bulk micro-parts using sheet metals seems quite promising as it avoids or facilitates billet handling, transportation, positioning, and ejection in the process chain. In this paper, an intensive review on the latest development of progressive microforming technologies is presented. First of all, the paper summarizes the characteristic of progressive microforming directly using sheet metal. The size effect-affected deformation behaviour and the dimensional accuracy, deformation load, ductile fracture, and the surface finish of the microformed parts by progressive microforming using sheet metals are then presented. Finally, some research issues from the implementation of mass production perspective are also discussed.

  15. Microform-related community patterns of methane-cycling microbes in boreal Sphagnum bogs are site specific.

    Science.gov (United States)

    Juottonen, Heli; Kotiaho, Mirkka; Robinson, Devin; Merilä, Päivi; Fritze, Hannu; Tuittila, Eeva-Stiina

    2015-09-01

    Vegetation and water table are important regulators of methane emission in peatlands. Microform variation encompasses these factors in small-scale topographic gradients of dry hummocks, intermediate lawns and wet hollows. We examined methane production and oxidization among microforms in four boreal bogs that showed more variation of vegetation within a bog with microform than between the bogs. Potential methane production was low and differed among bogs but not consistently with microform. Methane oxidation followed water table position with microform, showing higher rates closer to surface in lawns and hollows than in hummocks. Methanogen community, analysed by mcrA terminal restriction fragment length polymorphism and dominated by Methanoregulaceae or 'Methanoflorentaceae', varied strongly with bog. The extent of microform-related variation of methanogens depended on the bog. Methanotrophs identified as Methylocystis spp. in pmoA denaturing gradient gel electrophoresis similarly showed effect of bog, and microform patterns were stronger within individual bogs. Our results suggest that methane-cycling microbes in boreal Sphagnum bogs with seemingly uniform environmental conditions may show strong site-dependent variation. The bog-intrinsic factor may be related to carbon availability but contrary to expectations appears to be unrelated to current surface vegetation, calling attention to the origin of carbon substrates for microbes in bogs. © FEMS 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Tool Wear and Life Span Variations in Cold Forming Operations and Their Implications in Microforming

    Directory of Open Access Journals (Sweden)

    Anders E. W. Jarfors

    2016-12-01

    Full Text Available The current paper aims to review tooling life span, failure modes and models in cold microforming processes. As there is nearly no information available on tool-life for microforming the starting point was conventional cold forming. In cold forming common failures are (1 over stressing of the tool; (2 abrasive wear; (3 galling or adhesive wear, and (4 fatigue failure. The large variation in tool life observed in production and how to predict this was reviewed as this is important to the viability of microforming based on that the tooling cost takes a higher portion of the part cost. Anisotropic properties of the tool materials affect tool life span and depend on both the as-received and in-service conditions. It was concluded that preconditioning of the tool surface, and coating are important to control wear and fatigue. Properly managed, the detrimental effects from surface particles can be reduced. Under high stress low-cycle fatigue conditions, fatigue failure form internal microstructures and inclusions are common. To improve abrasive wear resistance larger carbides are commonly the solution which will have a negative impact on tooling life as these tend to be the root cause of fatigue failures. This has significant impact on cold microforming.

  17. Wildfire effects on vadose zone hydrology in forested boreal peatland microforms

    Science.gov (United States)

    Thompson, Dan K.; Waddington, James M.

    2013-04-01

    SummaryPeatland vulnerability to wildfire disturbance has been shown to vary as a function of hummock and hollow microforms and vadose zone hydrology, with low-lying hollow microforms most susceptible to deep combustion of peat. To better understand how this microform induced pattern of burning alters vadose water storage, pore-water pressure, and water table relationships, we examined a paired burned and unburned peatland in the boreal plain region of north central Alberta. Water table response to rain events increased significantly after wildfire, resulting in a more variable unsaturated zone thickness that was more responsive to smaller rain events. Water storage losses in the vadose zone occurred primarily at depths greater than 15 cm. Large peat surface water loss occurred in hummock microforms in the early spring due to the presence of unsaturated frozen peat at depth, likely a result of a vapour gradient from the unfrozen peat into the frozen peat underneath. During this period, the loss of water storage in the vadose zone satisfied up to 25% of daily evaporative demand, compared to only 3-5% during ice-free periods. A similar but less severe drying was observed late in summer, with burned hummocks the most vulnerable with high pore-water pressures. The enhanced surface drying observed is a precursor to high pore-water pressure conditions that inhibit Sphagnum regeneration. Our observations point to a paradox where the hummocks, being most resistant to combustion, are themselves most prone to high pore-water pressures following wildfire. The harsher hummock environment may contribute to the observed delay in post-fire Sphagnum regeneration in hummocks compared to hollows.

  18. Perceptions of cardiovascular health in underserved communities.

    Science.gov (United States)

    Bryant, Lucinda L; Chin, Nancy P; Cottrell, Lesley A; Duckles, Joyce M; Fernandez, I Diana; Garces, D Marcela; Keyserling, Thomas C; McMilin, Colleen R; Peters, Karen E; Samuel-Hodge, Carmen D; Tu, Shin-Ping; Vu, Maihan B; Fitzpatrick, Annette L

    2010-03-01

    Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions. Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences. Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials. Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.

  19. Unilateral microform cleft lip repair: application of muscle tension line group theory.

    Science.gov (United States)

    Yin, Ningbei; Song, Tao; Wu, Jiajun; Chen, Bo; Ma, Hengyuan; Zhao, Zhenmin; Wang, Yongqian; Li, Haidong; Wu, Di

    2015-03-01

    In microform cleft lip repair, reconstructing the elaborate structures is difficult. We describe a new technique of unilateral microform cleft lip repair that is based on the muscle tension line group theory. According to the shape of Cupid bow, a different small incision is used without creating an obvious cutaneous scar. First, the nasolabial muscle around the nasal floor (the first auxiliary tension line group) is reconstructed, and then the orbicularis oris muscle around the philtrum (the second auxiliary tension line group) is reconstructed based on the muscle tension line group theory. From June 2006 to June 2012, the technique was used in 263 unilateral microform cleft lip repairs. For 18 months, 212 patients were followed up. The appearance of the nasal alar, nasal sill, philtrum, and Cupid bow peak improved. Most patients had a satisfactory appearance. Based on the muscle tension line group theory, using this technique offers the ability to adduct the nasal alar effectively to form a good nasal sill and philtrum.

  20. A simple and low-cost Internet-based teleconsultation system that could effectively solve the health care access problems in underserved areas of developing countries.

    Science.gov (United States)

    Kuntalp, Mehmet; Akar, Orkun

    2004-08-01

    In many developing countries including Turkey, telemedicine systems are not in wide use due to the high cost and complexity of the required technology. Lack of these systems however has serious implications on patients who live in rural areas. The objective of this paper is to present a simple and economically affordable alternative to the current systems that would allow experts to easily access the medical data of their remote patients over the Internet. The system is developed in client-server architecture with a user-friendly graphical interface and various services are implemented as dynamic web pages based on PHP. The other key features of the system are its powerful security features and platform independency. An academic prototype is implemented and presented to the evaluation of a group of physicians. The results reveal that the system could find acceptance from the medical community and it could be an effective means of providing quality health care in developing countries.

  1. The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting

    Directory of Open Access Journals (Sweden)

    Anand Vinekar

    2014-01-01

    Full Text Available Aim: To report the Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP program for retinopathy of prematurity (ROP screening in underserved rural areas using an indigenously developed tele-ROP model. Materials and Methods: KIDROP currently provides ROP screening and treatment services in three zones and 81 neonatal units in Karnataka, India. Technicians were trained to use a portable Retcam Shuttle (Clarity, USA and validated against ROP experts performing indirect ophthalmoscopy. An indigenously developed 20-point score (STAT score graded their ability (Level I to III to image and decide follow-up based on a three-way algorithm. Images were also uploaded on a secure tele-ROP platform and accessed and reported by remote experts on their smart phones (iPhone, Apple. Results: 6339 imaging sessions of 1601 infants were analyzed. A level III technician agreed with 94.3% of all expert decisions. The sensitivity, specificity, positive predictive value and negative predictive value for treatment grade disease were 95.7, 93.2, 81.5 and 98.6 respectively. The kappa for technicians to decide discharge of babies was 0.94 (P < 0.001. Only 0.4% of infants needing treatment were missed.The kappa agreement of experts reporting on the iPhone vs Retcam for treatment requiring and mild ROP were 0.96 and 0.94 (P < 0.001 respectively. Conclusions: This is the first and largest real-world program to employ accredited non-physicians to grade and report ROP. The KIDROP tele-ROP model demonstrates that ROP services can be delivered to the outreach despite lack of specialists and may be useful in other middle-income countries with similar demographics.

  2. Development of in-situ observation system of dynamic contact interface between dies and materials during microforming operation

    Directory of Open Access Journals (Sweden)

    Shimizu Tetsuhide

    2015-01-01

    Full Text Available Application of diamond like carbon (DLC films are reported in several microforming processes, in view of its great tribological performance owe to the low friction and the high chemical stability. However, due to its high internal residual stress, the film properties with the low adhesion strength and the high wear rate under severe tribological conditions are still remain as technical issues. However, since the dynamic variation of the contact state cannot be observed during the forming operation, it is difficult to recognize the origin and the influential tribological factors of tool life for DLC coated microforming die. Therefore, the appropriate DLC film properties for the contact state in microforming operation have not been clarified. To observe the dynamic variation of the contact state during the microforming operation, present study developed a novel microforming die assembly installed the in-situ observation system with silica glass die and high speed recording camera. By using this system, the dynamic delamination behaviour of DLC films during the progressive micro-bending process was successfully demonstrated. The influential factors for the durability of DLC coated microdies were discussed.

  3. A National Longitudinal Survey of Medical Students' Intentions to Practice Among the Underserved.

    Science.gov (United States)

    O'Connell, Thomas F; Ham, Sandra A; Hart, Theodore G; Curlin, Farr A; Yoon, John D

    2018-01-01

    To explore students' intentions to practice in medically underserved areas. In January 2011, 960 third-year medical students from 24 MD-granting U.S. medical schools were invited to participate in a survey on their intention to practice in a medically underserved area. A follow-up survey was sent to participants in September 2011. Covariates included student demographics, medical school characteristics, environmental exposures, work experiences, sense of calling, and religious characteristics. Adjusted response rates were 564/919 (61.4%, first survey) and 474/564 (84.0%, follow-up survey). Among fourth-year medical students, an estimated 34.3% had an intention to practice among the underserved. In multivariate logistic regression modeling, predictors for intentions to practice among the underserved included growing up in an underserved setting (odds ratio [OR] range: 2.96-4.81), very strong sense of calling (OR range: 1.86-3.89), and high medical school social mission score (in fourth year: OR = 2.34 [95% confidence interval (CI), 1.31-4.21]). International experience was associated with favorable change of mind in the fourth year (OR = 2.86 [95% CI, 1.13-7.24]). High intrinsic religiosity was associated with intentions to practice primary care in underserved settings (in fourth year: OR = 2.29 [95% CI = 1.13-4.64]). Growing up in medically underserved settings, work experience in religiously affiliated organizations, very strong sense of calling, and high medical school social mission score were associated with intentions to practice in underserved areas. Lack of formative educational experiences may dissuade students from considering underserved practice.

  4. Fabrication of Times and Micro-Formation of Discourse at a Secondary School

    Directory of Open Access Journals (Sweden)

    Michalis Kontopodis

    2007-01-01

    Full Text Available The paper presented here starts with a reference to modernist time theories, followed by a presentation of alternative views in the works of FOUCAULT, DELEUZE, LATOUR and others. The study concentrates on the concrete context of an experimental school aiming at incorporation of excluded students into society. Based on the synthesis of discourse analysis and Actor-Network-Theory, the study puts forward a twofold question: a whether and how the "fabrication of times" is interrelated to micro-formations of discourses and b how micro-formations of discourses emerge as processes in the concrete setting of a school in regard to their temporal and other aspects. To answer this query, I combine some critical ethnographic work with an Actor-Network-Theory methodology—an approach which could be regarded as "rhizomatic analysis" (DELEUZE & GUATTARI, 1980. Examining discursive and non-discursive action with a particular focus on materialities (sites, students' documents, educational reports, CVs, and files, I introduce the notion of "temporal devices of control" and map two of them: that of synchronicity and that of convergence. In this way, I propose a new understanding of time and relate it to discourse formation. This, in turn, reveals a new potential for critical reflection on theories of time as well as on all action taking place in the school. URN: urn:nbn:de:0114-fqs0701119

  5. 36 CFR 1238.28 - What must agencies do when sending permanent microform records to a records storage facility?

    Science.gov (United States)

    2010-07-01

    ... 1232 of this chapter and the additional requirements in this section. (b) Package non-silver copies separately from the silver gelatin original or silver duplicate microform copy and clearly label them as non-silver copies. (c) Include the following information on the transmittal (SF 135 for NARA Federal Records...

  6. International Comparisons in Underserved Health: Issues, Policies, Needs and Projections.

    Science.gov (United States)

    Hutchinson, Paul; Morelli, Vincent

    2017-03-01

    Health care globally has made great strides; for example, there are lower rates of infant and maternal mortality. Increased incomes have led to lower rates of diseases accompanying poverty and hunger. There has been a shift away from the infectious diseases so deadly in developing nations toward first-world conditions. This article presents health care statistics across age groups and geographic areas to help the primary care physician understand these changes. There is a special focus on underserved populations. New technologies in health and health care spending internationally are addressed, emphasizing universal health care. The article concludes with recommendations for the future. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Implementing academic detailing for breast cancer screening in underserved communities

    Directory of Open Access Journals (Sweden)

    Ashford Alfred R

    2007-12-01

    Full Text Available Abstract Background African American and Hispanic women, such as those living in the northern Manhattan and the South Bronx neighborhoods of New York City, are generally underserved with regard to breast cancer prevention and screening practices, even though they are more likely to die of breast cancer than are other women. Primary care physicians (PCPs are critical for the recommendation of breast cancer screening to their patients. Academic detailing is a promising strategy for improving PCP performance in recommending breast cancer screening, yet little is known about the effects of academic detailing on breast cancer screening among physicians who practice in medically underserved areas. We assessed the effectiveness of an enhanced, multi-component academic detailing intervention in increasing recommendations for breast cancer screening within a sample of community-based urban physicians. Methods Two medically underserved communities were matched and randomized to intervention and control arms. Ninety-four primary care community (i.e., not hospital based physicians in northern Manhattan were compared to 74 physicians in the South Bronx neighborhoods of the New York City metropolitan area. Intervention participants received enhanced physician-directed academic detailing, using the American Cancer Society guidelines for the early detection of breast cancer. Control group physicians received no intervention. We conducted interviews to measure primary care physicians' self-reported recommendation of mammography and Clinical Breast Examination (CBE, and whether PCPs taught women how to perform breast self examination (BSE. Results Using multivariate analyses, we found a statistically significant intervention effect on the recommendation of CBE to women patients age 40 and over; mammography and breast self examination reports increased across both arms from baseline to follow-up, according to physician self-report. At post-test, physician

  8. Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve.

    Science.gov (United States)

    Odom Walker, Kara; Ryan, Gery; Ramey, Robin; Nunez, Felix L; Beltran, Robert; Splawn, Robert G; Brown, Arleen F

    2010-11-01

    We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work-life balance.

  9. Diet and Obesity Issues in the Underserved.

    Science.gov (United States)

    Mejia de Grubb, Maria C; Levine, Robert S; Zoorob, Roger J

    2017-03-01

    The goal of this article is to inform new directions for addressing inequalities associated with obesity by reviewing current issues about diet and obesity among socioeconomically vulnerable and underserved populations. It highlights recent interventions in selected high-risk populations, as well as gaps in the knowledge base. It identifies future directions in policy and programmatic interventions to expand the role of primary care providers, with an emphasis on those aimed at preventing obesity and promoting healthy weight. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Re-Presenting Slavery: Underserved Questions in Museum Collections

    Science.gov (United States)

    Levenson, Cyra

    2014-01-01

    This article looks at the notion of what, not who, is underserved in museum education. The importance of looking through, in, and from objects in order to uncover underserved questions and themes is vital. A willingness to consider new ways to approach collections and display is necessary to have a dialogue with our audiences about how museums can…

  11. Impact of selection strategies on representation of underserved populations and intention to practise: international findings.

    Science.gov (United States)

    Larkins, Sarah; Michielsen, Kristien; Iputo, Jehu; Elsanousi, Salwa; Mammen, Marykutty; Graves, Lisa; Willems, Sara; Cristobal, Fortunato L; Samson, Rex; Ellaway, Rachel; Ross, Simone; Johnston, Karen; Derese, Anselme; Neusy, André-Jacques

    2015-01-01

    Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions. A cross-sectional questionnaire was administered to students starting medical education in five institutions with a social accountability mandate in five different countries. The questionnaire assessed students' background characteristics, rurality of background, and practice intentions (location, discipline of practice and population to be served). The results were compared with the characteristics of students entering medical education in schools with standard selection procedures, and with publicly available socio-economic data. The selection processes of all five schools included strategies that extended beyond the assessment of academic achievement. Four distinct strategies were identified: the quota system; selection based on personal attributes; community involvement, and school marketing strategies. Questionnaire data from 944 students showed that students at the five schools were more likely to be of non-urban origin, of lower socio-economic status and to come from underserved groups. A total of 407 of 810 (50.2%) students indicated an intention to practise in a non-urban area after graduation and the likelihood of this increased with increasing rurality of primary schooling (p = 0.000). Those of rural origin were statistically less likely to express an intention to work abroad (p = 0.003). Selection strategies to ensure that members of underserved communities

  12. Community mobilisation with women's groups facilitated by Accredited Social Health Activists (ASHAs to improve maternal and newborn health in underserved areas of Jharkhand and Orissa: study protocol for a cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Sinha Rajesh

    2011-07-01

    Full Text Available Abstract Background Around a quarter of the world's neonatal and maternal deaths occur in India. Morbidity and mortality are highest in rural areas and among the poorest wealth quintiles. Few interventions to improve maternal and newborn health outcomes with government-mandated community health workers have been rigorously evaluated at scale in this setting. The study aims to assess the impact of a community mobilisation intervention with women's groups facilitated by ASHAs to improve maternal and newborn health outcomes among rural tribal communities of Jharkhand and Orissa. Methods/design The study is a cluster-randomised controlled trial and will be implemented in five districts, three in Jharkhand and two in Orissa. The unit of randomisation is a rural cluster of approximately 5000 population. We identified villages within rural, tribal areas of five districts, approached them for participation in the study and enrolled them into 30 clusters, with approximately 10 ASHAs per cluster. Within each district, 6 clusters were randomly allocated to receive the community intervention or to the control group, resulting in 15 intervention and 15 control clusters. Randomisation was carried out in the presence of local stakeholders who selected the cluster numbers and allocated them to intervention or control using a pre-generated random number sequence. The intervention is a participatory learning and action cycle where ASHAs support community women's groups through a four-phase process in which they identify and prioritise local maternal and newborn health problems, implement strategies to address these and evaluate the result. The cycle is designed to fit with the ASHAs' mandate to mobilise communities for health and to complement their other tasks, including increasing institutional delivery rates and providing home visits to mothers and newborns. The trial's primary endpoint is neonatal mortality during 24 months of intervention. Additional

  13. Recruitment practices for U.S. minority and underserved populations in NRG oncology: Results of an online survey

    Directory of Open Access Journals (Sweden)

    Elise D. Cook

    2018-06-01

    Full Text Available Introduction: Cancer clinical trials (CCT provide much of the evidence for clinical guidelines and standards of care. But low levels of CCT participation are well documented, especially for minorities. Methods and materials: We conducted an online survey of 556 recruitment practices across the NRG Oncology network. Survey aims were 1 to learn how sites recruit minority/underserved populations; 2 to better understand the catchment areas of the NRG institutions; and 3 to aid in planning education programs for accrual of minority/underserved populations. Results: The survey response rate was 34.9%. The most effective methods reported for recruiting minority/underserved participants were patient navigators (44.4% and translators (38.9%. All institutions reported using a mechanism for eligibility screening and 71% of institutions reported using a screening/enrollment tracking system. CCT training was required at 78.1% and cultural competency training was required at 47.5% of responding institutions. Only 19.9% of sites used community partners to assist with minority recruitment and just 37.1% of respondents reported a defined catchment area. Sites reported very little race and ethnicity data. Conclusion: This NRG Oncology online survey provides useful data for improvements in trial enrollment and training to recruit minority/underserved populations to CCT. Areas for further investigation include web-based methods for recruitment and tracking, cultural competency training, definition of catchment areas, use of patient navigators, and community partnerships. The survey results will guide recruitment training programs.

  14. Effects of a psychological skills training programme for underserved ...

    African Journals Online (AJOL)

    Effects of a psychological skills training programme for underserved rugby ... The development of psychological skills is an important, but often neglected part of ... Repeated measures two-way ANOVAs revealed significant main time effects, ...

  15. Improving Maternal and Child Health in Underserved Rural Areas of ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Maternal and child health is a priority for Nigeria, but there are significant challenges and opportunities at state levels that influence efforts to reduce deaths. This project will contribute to government efforts in Delta State to improve delivery and use of maternal and child healthcare services in three marginalized rural ...

  16. 77 FR 35245 - Substantially Underserved Trust Areas (SUTA)

    Science.gov (United States)

    2012-06-13

    ... statute (7 U.S.C. 306F (B)(2)) added to the RE Act as part of the Food, Conservation and Energy Act of... governments and is mindful of their sovereignty. The agency engages with tribes on a government to government...

  17. 76 FR 63846 - Substantially Underserved Trust Areas (SUTA)

    Science.gov (United States)

    2011-10-14

    ... Cost Rural Communities; 10.861, Public Television Station Digital Transition Grant Program; 10.862... rule do not impose substantial unreimbursed direct compliance costs on Indian tribal, Alaska native, or native Hawaiian governments and sovereign institutions or have tribal implications that preempt tribal...

  18. Engaging with Underserved Urban Communities on Climate Resilience

    Science.gov (United States)

    Akerlof, K.; Moser, F. C.; Baja, K.; Dindinger, J. M.; Chanse, V.; Rowan, K. E.; Rohring, B.

    2016-12-01

    Meeting the needs of urban high-risk/low-resource communities is one of the most critical challenges in improving climate resilience nationally, but little tailored information exists to guide community engagement efforts specifically for these contexts. This case study describes a collaboration between universities, local governments, and community members working in underserved neighborhoods of the City of Baltimore and Prince George's County, Maryland. In service of current and developing community programs, the team surveyed residents door-to-door about their perceptions of the socio-environmental risks they face, their priorities for change, and the ways in which communication may build protective social capital. We highlight theoretical, applied, and pedagogical aspects of the study that inform both the promise and limitations of these collaborations. These include: 1) the role of citizen participation in climate adaptation decision-making; 2) the meaning, use, and potential impact of community data; 3) balancing differing organizational priorities, timelines, and cultures within community-based projects; and 4) research participation of undergraduate students. The results of the survey illuminate climate risk perceptions in neighborhoods facing complex stressors with lessons for communication and engagement in other urban areas facing similar adaptation challenges.

  19. Creating A Sustainable Model of Spine Care in Underserved Communities

    DEFF Research Database (Denmark)

    Haldeman, Scott; Nordin, Margareta; Outerbridge, Geoff

    2015-01-01

    The world lacks sustainable models of care to manage spinal disorders in poor and underserved communities. The purpose of this article is to: (1) review the rationale and importance of developing a sustainable evidence-based model of care at low cost for people with spinal disorders in underserved...... adequate care, World Spine Care (WSC) was established to "improve lives in underserved communities through sustainable, integrated, evidence-based, spinal care." WSC is comprised of volunteers and institutions from 6 continents and several countries, and incorporates a Board of Directors, an executive...... are adapted to and integrated within each community in collaboration with local decision makers, existing health care workers and traditional healers. Cornerstones of WSC's emphasis on long-term sustainability are (1) education of community partners, governments and local health professionals, and (2...

  20. Occupational safety and health education and training for underserved populations.

    Science.gov (United States)

    O'Connor, Tom; Flynn, Michael; Weinstock, Deborah; Zanoni, Joseph

    2014-01-01

    This article presents an analysis of the essential elements of effective occupational safety and health education and training programs targeting underserved communities. While not an exhaustive review of the literature on occupational safety and health training, the paper provides a guide for practitioners and researchers to the key factors they should consider in the design and implementation of training programs for underserved communities. It also addresses issues of evaluation of such programs, with specific emphasis on considerations for programs involving low-literacy and limited-English-speaking workers.

  1. Chronic disease management in rural and underserved populations: innovation and system improvement help lead to success.

    Science.gov (United States)

    Bolin, Jane; Gamm, Larry; Kash, Bita; Peck, Mitchell

    2005-03-01

    Successful implementation of disease management (DM) is based on the ability of an organization to overcome a variety of barriers to deliver timely, appropriate care of chronic illnesses. Such programs initiate DM services to patient populations while initiating self-management education among medication-resistant patients who are chronically ill. Despite formidable challenges, rural health care providers have been successful in initiating DM programs and have discovered several ways in which these programs benefit their organizations. This research reports on six DM programs that serve large rural and underserved populations and have demonstrated that DM can be successfully implemented in such areas.

  2. Occupational Health and Sleep Issues in Underserved Populations.

    Science.gov (United States)

    Kalliny, Medhat; McKenzie, Judith Green

    2017-03-01

    Sleep disorders and occupational hazards, injuries, and illnesses impact an individual's overall health. In the United States, substantial racial, ethnic, and socioeconomic disparities exist in sleep and occupational health. Primary care physicians working in underserved communities should be aware of this disparity and target these higher-risk populations for focused evaluation and intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. The Online-Counseling Debate: A View toward the Underserved

    Science.gov (United States)

    Sanchez-Page, Delida

    2005-01-01

    This article responds to some important issues that Mallen, Vogel, Rochlen, and Day raise in "Online Counseling: Reviewing the Literature from a Counseling Psychology Framework." This reaction reviews the appropriateness of online counseling for underserved populations. The author provides suggestions for better serving historically undeserved…

  4. Empowering underserved populations through cancer prevention and early detection.

    Science.gov (United States)

    Rivera-Colón, Venessa; Ramos, Roberto; Davis, Jenna L; Escobar, Myriam; Inda, Nikki Ross; Paige, Linda; Palencia, Jeannette; Vives, Maria; Grant, Cathy G; Green, B Lee

    2013-12-01

    It is well documented that cancer is disproportionately distributed in racial/ethnic minority groups and medically underserved communities. In addition, cancer prevention and early detection represent the key defenses to combat cancer. The purpose of this article is to showcase the comprehensive health education and community outreach activities at the H. Lee Moffitt Cancer Center and Research Institute (Moffitt) designed to promote and increase access to and utilization of prevention and early detection services among underserved populations. One of Moffitt's most important conduits for cancer prevention and early detection among underserved populations is through its community education and outreach initiatives, in particular, the Moffitt Program for Outreach Wellness Education and Resources (M-POWER). M-POWER works to empower underserved populations to make positive health choices and increase screening behaviors through strengthening collaboration and partnerships, providing community-based health education/promotion, and increasing access to care. Effective, empowering, and culturally and linguistically competent health education and community outreach, is key to opening the often impenetrable doors of cancer prevention and early detection to this society's most vulnerable populations.

  5. Exercise and Sports Medicine Issues in Underserved Populations.

    Science.gov (United States)

    Morelli, Vincent; Bedney, Daniel L; Eric Dadush, Arie

    2017-03-01

    Primary care providers can make a strong argument for exercise promotion in underserved communities. The benefits are vitally important in adolescent physical, cognitive, and psychological development as well as in adult disease prevention and treatment. In counseling such patients, we should take into account a patient's readiness for change and the barriers to exercise. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Factors Associated With Medical School Graduates' Intention to Work With Underserved Populations: Policy Implications for Advancing Workforce Diversity.

    Science.gov (United States)

    Garcia, Andrea N; Kuo, Tony; Arangua, Lisa; Pérez-Stable, Eliseo J

    2018-01-01

    Given projected U.S. physician shortages across all specialties that will likely impact underserved areas disproportionately, the authors sought to explore factors most correlated with medical school graduates' intention to work with underserved populations (IWUP). Data from the 2010-2012 Association of American Medical Colleges Medical School Graduation Questionnaire (n = 40,846) were analyzed. Variables (demographics, career preference, debt burden, intention to enter loan forgiveness programs) were examined using chi-square tests and logistic regression models. Respondents included 49.5% (20,228/40,846) women, 16.6% (6,771/40,837) underrepresented minorities (URMs), and 32.4% (13,034/37,342) with primary care intent. The median educational debt was $160,000. Respondents who were women (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.49, 1.70), URMs (aOR 2.50, 95% CI 2.30, 2.72), intended to enter loan forgiveness programs (aOR 2.44, 95% CI 2.26, 2.63), intended to practice primary care (aOR 1.65, 95% CI 1.54, 1.76), and intended to emphasize nonclinical careers (aOR 1.23, 95% CI 1.11, 1.37) had greater odds of reporting IWUP. Among those who chose specialties and careers with a nonclinical emphasis, and among those with greater burdens of educational and consumer debt, URMs were nearly twice as likely as other minorities and whites to report IWUP. Findings suggest physician characteristics that may be associated with filling workforce gaps in underserved areas. Restructuring financial incentive programs to support physician leaders and specialists with characteristics associated with IWUP may complement similar policies in primary care and could have key impacts on health equity in underserved areas.

  7. Leadership Advocacy: Bringing Nursing to the Homeless and Underserved.

    Science.gov (United States)

    Porter-OʼGrady, Tim

    Nurses have historically played a key role in advocacy and service for all members of the community, including those who are traditionally underserved by other providers or the health system. Nurses from a local Atlanta community health system, both clinical and administrative, have continued this tradition by developing an advocacy and service program for the downtown homeless of Atlanta. From its beginnings as a highly informal volunteer program to its current structure as a strongly integrated community health center for the underserved and homeless of Atlanta, local nurses have demonstrated their strong value of service advocacy. Their leadership, insight, discipline, and strategic development have facilitated the growth of a focused, viable health service network for marginalized people of the city of Atlanta.

  8. Impact of a regional distributed medical education program on an underserved community: perceptions of community leaders.

    Science.gov (United States)

    Toomey, Patricia; Lovato, Chris Y; Hanlon, Neil; Poole, Gary; Bates, Joanna

    2013-06-01

    To describe community leaders' perceptions regarding the impact of a fully distributed undergraduate medical education program on a small, medically underserved host community. The authors conducted semistructured interviews in 2007 with 23 community leaders representing, collectively, the education, health, economic, media, and political sectors. They reinterviewed six participants from a pilot study (2005) and recruited new participants using purposeful and snowball sampling. The authors employed analytic induction to organize content thematically, using the sectors as a framework, and they used open coding to identify new themes. The authors reanalyzed transcripts to identify program outcomes (e.g., increased research capacity) and construct a list of quantifiable indicators (e.g., number of grants and publications). Participants reported their perspectives on the current and anticipated impact of the program on education, health services, the economy, media, and politics. Perceptions of impact were overwhelmingly positive (e.g., increased physician recruitment), though some were negative (e.g., strains on health resources). The authors identified new outcomes and confirmed outcomes described in 2005. They identified 16 quantifiable indicators of impact, which they judged to be plausible and measureable. Participants perceive that the regional undergraduate medical education program in their community has broad, local impacts. Findings suggest that early observed outcomes have been maintained and may be expanding. Results may be applicable to medical education programs with distributed or regional sites in similar rural, remote, and/or underserved regions. The areas of impact, outcomes, and quantifiable indicators identified will be of interest to future researchers and evaluators.

  9. Find Shortage Areas: HPSA & MUA/P by Address

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Find Shortage Areas: Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) by Address tool helps you determine if a specific...

  10. The Inwood Astronomy Project: 100 Nights in Manhattan---An Outreach Initiative to Underserved Communities

    Science.gov (United States)

    Kendall, J. S.

    2008-11-01

    Observing the night sky in New York City is a challenge. However, there is a popular, and even club-going, interest in science in New York City. On the edges of that interest, most people that live in New York City have never had the opportunity to look through a telescope, particularly in underserved areas such as Northern Manhattan. The presenter discusses plans for frequent observing sessions utilizing the parks in New York City combined with public classes at the New York Public Library. Both observing sessions and classes will be held in the ethnically, racially and economically diverse Bronx and Manhattan neighborhoods of Washington Heights, Marble Hill and Inwood. Integration with area middle, elementary and high schools is also discussed. Particular issues surrounding publicity and the need for showmanship in an image-driven community with numerous entertainment opportunities are also discussed.

  11. Crowdsourced Microfinance for Energy Efficiency in Underserved Communities

    Energy Technology Data Exchange (ETDEWEB)

    Baird, Donnel [BlocPower LLC, New York, NY (United States); Cox, Morris [BlocPower LLC, New York, NY (United States); Harmarneh, Sarey [BlocPower LLC, New York, NY (United States); Zheng, Chen [BlocPower LLC, New York, NY (United States)

    2017-06-21

    BlocPower’s mission is to provide access to energy efficiency financing for underserved communities across the United States. This project, “Crowdsourced Microfinance for Energy Efficiency in Underserved Communities,” is an extension of that goal and is grounded in the principles of providing engineering and financing services to those in need. The project is based on the creation of a BlocPower Marketplace as a central hub for connecting shovel-ready green buildings to institutional investors. This ‘connection’ entails using online crowdfunding to aggregate debt and equity capital from institutional investors to connect to customers (building owners) across various financial portfolios. BlocPower Marketplace is intended to bring social, environmental, and financial returns to investors while also decreasing investor risk by loaning out funds for energy installations in individual buildings. In detail, the intended benefits of crowdsourcing are two-sided. Firstly, for building owners, clean energy retrofit installations improve building operations, reduce utility costs, and reduce harmful impacts to their surrounding environment. Secondly, for institutional investors, they gain access to a new market of energy efficiency and are able to provide debt or equity capital with high financial returns. This gives investors the opportunity to create social and environmental impact in communities around the country as well. With this in mind, BlocPower designed the marketplace to specifically answer exploratory research questions with respect to the pricing of energy financing. Institutional investors typically charge high rates on project financing solutions in the energy space, particularly in low and middle-income communities, because of fears that required debt service will not be made. This makes access to energy capital exorbitantly difficult for those that need it the most. Through this project, BlocPower tested investor appetite to determine if

  12. Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities.

    Science.gov (United States)

    Uscher-Pines, Lori; Rudin, Robert; Mehrotra, Ateev

    2017-06-01

    Many disadvantaged communities lack sufficient numbers of local primary care and specialty physicians. Yet tens of thousands of physicians, in particular those who are retired or semiretired, desire meaningful volunteer opportunities. Multiple programs have begun to use telehealth to bridge the gap between volunteer physicians and underserved patients. In this brief, we describe programs that are using this model and discuss the promise and pitfalls. Physician volunteers in these programs report that the work can be fulfilling and exciting, a cutting-edge yet convenient way to remain engaged and contribute. Given the projected shortfall of physicians in the United States, recruiting retired and semiretired physicians to provide care through telehealth increases the total supply of active physicians and the capacity of the existing workforce. However, programs typically use volunteers in a limited capacity because of uncertainty about the level and duration of commitment. Acknowledging this reality, most programs only use volunteer physicians for curbside consults rather than fully integrating them into longitudinal patient care. The part-time availability of volunteers may also be difficult to incorporate into the workflow of busy safety net clinics. As more physicians volunteer in a growing number of telehealth programs, the dual benefits of enriching the professional lives of volunteers and improving care for underserved communities will make further development of these programs worthwhile.

  13. Physical Activity in an Underserved Population: Identifying Technology Preferences.

    Science.gov (United States)

    Medairos, Robert; Kang, Vicky; Aboubakare, Carissa; Kramer, Matthew; Dugan, Sheila Ann

    2017-01-01

    This study aims to identify patterns of use and preferences related to technology platforms that could support physical activity (PA) programs in an underserved population. A 29-item questionnaire was administered at 5 health and wellness sites targeting low income communities in Chicago. Frequency tables were generated for Internet, cell phone, and social media use and preferences. Chi-squared analysis was used to evaluate differences across age and income groups. A total of 291 individuals participated and were predominantly female (69.0%). Majority reported incomes less than $30,000 (72.9%) and identified as African American/Black/Caribbean (49.3%) or Mexican/Mexican American (34.3%). Most participants regularly used smartphones (63.2%) and the Internet (75.9%). Respondents frequently used Facebook (84.8%), and less commonly used Instagram (43.6%), and Twitter (20.0%). Free Internet-based exercise programs were the most preferred method to increase PA levels (31.6%), while some respondents (21.0%) thought none of the surveyed technology applications would help. Cell phone, Internet, and social media use is common among the surveyed underserved population. Technology preferences to increase PA levels varied, with a considerable number of respondents not preferring the surveyed technology platforms. Creating educational opportunities to increase awareness may maximize the effectiveness of technology-based PA interventions.

  14. Sleep duration of underserved minority children in a cross-sectional study

    Science.gov (United States)

    Short sleep duration has been shown to associate with increased risk of obesity. Childhood obesity is more prevalent among underserved minority children. The study measured the sleep duration of underserved minority children living in a large US urban environment using accelerometry and its relation...

  15. Caregiver's depressive symptoms and asthma control in children from an underserved community.

    Science.gov (United States)

    Rioseco, Andrea; Serrano, Carolina; Celedón, Juan C; Padilla, Oslando; Puschel, Klaus; Castro-Rodriguez, Jose A

    2017-12-01

    Caregiver's or maternal depression has been associated with increased asthma morbidity in children from prosperous nations, but little is known about this link in low and middle-income countries. To examine if caregiver's depressive symptoms are associated with poor asthma control and abnormal immune responses in school-aged children. Case-control study of 87 asthmatic children (aged 4-11 years) attending a primary care clinic in an underserved area of Santiago (Chile). Cases were children with poor asthma control (Child Asthma Control Test [cACT] asthma control (cACT ≥20 points). The Beck Depression Inventory-II (BDI) and a locally validated family health vulnerability test (SALUFAM) were used to assess caregivers' depression and family health vulnerability. Serum from participating children was assayed for IFN-γ, IL-4, IL-13, TGF-β, cortisol, and total IgE. The mean (SD) age of study participants was 8.23 (2.15 years), and 55.2% were females. Use of inhaled corticosteroids (ICS), family health vulnerability, and caregiver's depressive symptoms were significantly more common in cases than in controls (65.4% vs. 34.6%, p = 0.003; 41.3% vs. 24.8%, p = 0.07; and 39.1% vs. 19.5%, p = 0.04, respectively). There was no significant difference in the level of any serum biomarkers between groups. In a multivariate analysis, only ICS use was significantly associated with better asthma control (OR = 3.56 [1.34-9.48], p = 0.01). Presence of caregiver's depressive symptoms is associated with poor asthma control among children from an underserved community, but this association was no longer significant after accounting for ICS use.

  16. Intercultural health and ethnobotany: how to improve healthcare for underserved and minority communities?

    Science.gov (United States)

    Vandebroek, Ina

    2013-07-30

    The present conceptual review explores intercultural healthcare--defined as the integration of traditional medicine and biomedicine as complementary healthcare systems--in minority and underserved communities. This integration can take place at different levels: individuals (patients, healers, biomedical healthcare providers), institutions (health centers, hospitals) or society (government policy). Contemporary ethnobotany research of traditional medicine has primarily dealt with the botanical identification of plants commonly used by local communities, and the identification of health conditions treated with these plants, whereas ethnopharmacology has focused on the bioactivity of traditional remedies. On the other hand, medical anthropology seems to be the scholarship more involved with research into patients' healthcare-seeking itineraries and their interaction with traditional versus biomedical healthcare systems. The direct impact of these studies on public health of local communities can be contested. To compare and discuss the body of scholarly work that deals with different aspects of traditional medicine in underserved and minority communities, and to reflect on how gaps identified in research can be bridged to help improve healthcare in these communities. The literature covers a broad range of information of relevance to intercultural healthcare. This information is fragmented across different scientific and clinical disciplines. A conceptual review of these studies identifies a clear need to devote more attention to ways in which research on traditional medicine can be more effectively applied to improve local public health in biomedical resource-poor settings, or in geographic areas that have disparities in access to healthcare. Scholars studying traditional medicine should prioritize a more interdisciplinary and applied perspective to their work in order to forge a more direct social impact on public health in local communities most in need of

  17. Recruiting Underserved Mothers to Medical Research: Findings from North Carolina

    Science.gov (United States)

    Spears, Chaya R.; Sandberg, Joanne C.; O’Neill, Jenna L.; Grzywacz, Joseph G.; Howard, Timothy D.; Feldman, Steven R.; Arcury, Thomas A.

    2014-01-01

    Representative samples are required for ethical, valid, and useful health research. Yet, recruiting participants, especially from historically underserved communities, can be challenging. This paper presents findings from in-depth interviews with 40 mothers about factors that might influence their willingness to participate or allow their children to participate in medical research. Saliency analysis organizes the findings. Frequent and important salient themes about research participation included concerns that it might cause participants harm, hope that participants might gain a health benefit, and recognition that time and transportation resources could limit participation. Ultimately, we propose that a theoretical model, such as the Theory of Planned Behavior (TPB), will facilitate more systematic evaluation of effective methods for recruitment and retention of participants in medical research. Future research should explore the utility of such a model for development of effective recruitment and retention strategies. PMID:24185171

  18. HealthATM: personal health cyberinfrastructure for underserved populations.

    Science.gov (United States)

    Botts, Nathan E; Horan, Thomas A; Thoms, Brian P

    2011-05-01

    There is an opportunity for personal health record (PHR) systems to play a vital role in fostering health self-management within underserved populations. If properly designed and promoted, it is possible that patients will use PHRs to become more empowered in taking an active role toward managing their health needs. This research examines the potential of a cyberinfrastructure-based PHR to encourage patient activation in health care, while also having population health implications. A multi-phased, iterative research approach was used to design and evaluate a PHR system called HealthATM, which utilizes services from a cloud computing environment. These services were integrated into an ATM-style interface aimed at providing a broad range of health consumers with the ability to manage health conditions and encourage accomplishment of health goals. Evaluation of the PHR included 115 patients who were clients of several free clinics in Los Angeles County. The majority of patients perceived ease of use (74%) and confidence (73%) in using the HealthATM system, and thought they would like to use it frequently (73%). Patients also indicated a belief in being responsible for their own health. However, fewer felt as though they were able to maintain necessary life changes to improve their health. Findings from the field tests suggest that PHRs can be a beneficial health management tool for underserved populations. In order for these types of tools to be effective within safety-net communities, they must be technically accessible and provide meaningful opportunities to increase patient engagement in their health care. Copyright © 2011. Published by Elsevier Inc.

  19. Enrolling Minority and Underserved Populations in Cancer Clinical Research.

    Science.gov (United States)

    Wallington, Sherrie F; Dash, Chiranjeev; Sheppard, Vanessa B; Goode, Tawara D; Oppong, Bridget A; Dodson, Everett E; Hamilton, Rhonda N; Adams-Campbell, Lucile L

    2016-01-01

    Research suggests that community involvement is integral to solving public health problems, including involvement in clinical trials-a gold standard. Significant racial/ethnic disparities exist in the accrual of participants for clinical trials. Location and cultural aspects of clinical trials influence recruitment and accrual to clinical trials. It is increasingly necessary to be aware of defining characteristics, such as location and culture of the populations from which research participants are enrolled. Little research has examined the effect of location and cultural competency in adapting clinical trial research for minority and underserved communities on accrual for clinical trials. Utilizing embedded community academic sites, the authors applied cultural competency frameworks to adapt clinical trial research in order to increase minority participation in nontherapeutic cancer clinical trials. This strategy resulted in successful accrual of participants to new clinical research trials, specifically targeting participation from minority and underserved communities in metropolitan Washington, DC. From 2012 to 2014, a total of 559 participants enrolled across six nontherapeutic clinical trials, representing a 62% increase in the enrollment of blacks in clinical research. Embedding cancer prevention programs and research in the community was shown to be yet another important strategy in the arsenal of approaches that can potentially enhance clinical research enrollment and capacity. The analyses showed that the capacity to acquire cultural knowledge about patients-their physical locales, cultural values, and environments in which they live-is essential to recruiting culturally and ethnically diverse population samples. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  20. Examining e-Health literacy and the digital divide in an underserved population in Hawai'i.

    Science.gov (United States)

    Connolly, Kathleen Kihmm; Crosby, Martha E

    2014-02-01

    Seeking health information is one of the leading uses for the Internet and World Wide Web (WWW). Research has found the amount one benefits from e-Health information (health information from electronic sources) is directly related to the level of e-Health literacy. e-Health literacy is defined as "the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem." In order to gain a further understanding of the effects and use of technology, the digital divide, and the relationship between technology utilization and health outcomes, focus group interviews were conducted with participants diagnosed with diabetes and currently residing in a Medically Underserved Area. Overall, 25 volunteers participated in the four focus group meetings. Based on the focus group discussions, a general low e-Health literacy rate was identified. This was demonstrated by the lack of access to the Internet and the skills needed to retrieve health information. Of the 25 participants, 64% reported having Internet access at some level, but, only one reported going on the Internet every day. When the barriers to using the Internet were discussed, many participants expressed a lack of knowledge in how to retrieve information. Results of this study further show that having access to technology is not necessarily associated with usage. This dynamic is evolving into a new form of digital divide, gap in information retrieval and usage, versus gap in access. This is the first known study to examine e-Health literacy in an underserved population in Hawai'i. With the proliferation of information and communication technology and the transformation of information retrieval to be mobile and "on demand", a multi-pronged communication and education strategy is needed to explore how technology can improve e-Health literacy and health outcomes among underserved populations.

  1. Examining e-Health Literacy and the Digital Divide in an Underserved Population in Hawai‘i

    Science.gov (United States)

    Crosby, Martha E

    2014-01-01

    Seeking health information is one of the leading uses for the Internet and World Wide Web (WWW). Research has found the amount one benefits from e-Health information (health information from electronic sources) is directly related to the level of e-Health literacy. e-Health literacy is defined as “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem.” In order to gain a further understanding of the effects and use of technology, the digital divide, and the relationship between technology utilization and health outcomes, focus group interviews were conducted with participants diagnosed with diabetes and currently residing in a Medically Underserved Area. Overall, 25 volunteers participated in the four focus group meetings. Based on the focus group discussions, a general low e-Health literacy rate was identified. This was demonstrated by the lack of access to the Internet and the skills needed to retrieve health information. Of the 25 participants, 64% reported having Internet access at some level, but, only one reported going on the Internet every day. When the barriers to using the Internet were discussed, many participants expressed a lack of knowledge in how to retrieve information. Results of this study further show that having access to technology is not necessarily associated with usage. This dynamic is evolving into a new form of digital divide, gap in information retrieval and usage, versus gap in access. This is the first known study to examine e-Health literacy in an underserved population in Hawai‘i. With the proliferation of information and communication technology and the transformation of information retrieval to be mobile and “on demand”, a multi-pronged communication and education strategy is needed to explore how technology can improve e-Health literacy and health outcomes among underserved populations. PMID:24567867

  2. Examining the Influence of Cost Concern and Awareness of Low-cost Health Care on Cancer Screening among the Medically Underserved.

    Science.gov (United States)

    Best, Alicia L; Strane, Alcha; Christie, Omari; Bynum, Shalanda; Wiltshire, Jaqueline

    2017-01-01

    African Americans suffer a greater burden of mortality from breast, cervical, and colorectal cancers than other groups in the United States. Early detection through timely screening can improve survival outcomes; however, cost is frequently reported as a barrier to screening. Federally qualified health centers (FQHCs) provide preventive and primary care to underserved populations regardless of ability to pay, positioning them to improve cancer screening rates. The purpose of this study was to examine the influence of concern about health care cost (cost concern) and awareness of low-cost health care (awareness) on cancer screening among 236 African Americans within an FQHC service area using self-report surveys. Multiple logistic regression indicated that awareness was positively associated with cervical and colorectal cancer screening, while cost concern was negatively associated with mammography screening. Results indicate that improving awareness and understanding of low-cost health care could increase cancer screening among underserved African Americans.

  3. With Educational Benefits for All: Campus Inclusion through Learning Communities Designed for Underserved Student Populations

    Science.gov (United States)

    Fink, John E.; Hummel, Mary L.

    2015-01-01

    This chapter explores the practices of learning communities designed for specific, underserved student populations, highlighting on-campus examples and culminating with a synthesized list of core practices from these "inclusive" learning communities.

  4. Lack of Quality Primary Health Services: The Problems of the Underserved.

    Science.gov (United States)

    Hall, Daniel A.

    1978-01-01

    Major political and economic forces, which affect the provision of primary health services, particularly to underserved populations, are reviewed. Technological, professional, governmental, fiscal, and societal solutions are proposed. (GC)

  5. Breast Cancer Outreach for Underserved Women: A Randomized Trial and Cost-Effectiveness Analysis

    National Research Council Canada - National Science Library

    Pasick, Rena

    1999-01-01

    The current study, BACCIS-II, is a randomized controlled trial of an outreach intervention model designed to increase the rate of periodic mammography and clinical breast exam among underserved women...

  6. Designing for Underserved Populations: Constraints and Requirements of Personal Health Record Systems

    Centers for Disease Control (CDC) Podcasts

    In this podcast, Dr. Thomas Horan discusses how language, literacy, and access barriers can be overcome with electronic Personal Health Record (PHR) systems to improve health among the most vulnerable, isolated, and underserved populations.

  7. LifeSteps: An Evidence-based Health Promotion Program for Underserved Populations – A Community Service Learning Approach

    Directory of Open Access Journals (Sweden)

    Melanie Austin-McCain

    2015-04-01

    Full Text Available Chronic diseases are the most common, costly, and preventable of all health problems in the United States. Chronic diseases represent the leading causes of death and are experienced at higher rates by minority populations (CDC, 2012. Innovative community-based health promotion programs are recommended that meet the diverse needs of underserved populations (Yeary, et al., 2011. LifeSteps is being developed as an evidence-based health promotion program focusing on health and wellness, a domain area defined within the Occupational Therapy Practice Framework (OTPF, 2008. LifeSteps will utilize a client-centered approach to coach individuals in making health behavior changes. Fieldwork and service-learning components are incorporated integrating clinical practice, academic study, and collaboration with community providers. Program evaluation measures based on the Transtheoretical Model (TTM have been identified to address all phases of program planning. The LifeSteps health promotion program aligns with local, national, and international objectives and addresses the need for programs that meet the diverse needs of underserved populations. Occupational therapists are in a unique position for implementing community-based interventions that promote health and contribute to a healthier society.

  8. Pediatric Asthma Care Coordination in Underserved Communities: A Quasiexperimental Study.

    Science.gov (United States)

    Janevic, Mary R; Stoll, Shelley; Wilkin, Margaret; Song, Peter X K; Baptist, Alan; Lara, Marielena; Ramos-Valencia, Gilberto; Bryant-Stephens, Tyra; Persky, Victoria; Uyeda, Kimberly; Lesch, Julie Kennedy; Wang, Wen; Malveaux, Floyd J

    2016-11-01

    To assess the effect of care coordination on asthma outcomes among children in underserved urban communities. We enrolled children, most of whom had very poorly or not well-controlled asthma, in medical-social care coordination programs in Los Angeles, California; Chicago, Illinois; Philadelphia, Pennsylvania; and San Juan, Puerto Rico in 2011 to 2014. Participants (n = 805; mean age = 7 years) were 60% male, 50% African American, and 42% Latino. We assessed asthma symptoms and health care utilization via parent interview at baseline and 12 months. To prevent overestimation of intervention effects, we constructed a comparison group using bootstrap resampling of matched control cases from previous pediatric asthma trials. At follow-up, intervention participants had 2.2 fewer symptom days per month (SD = 0.3; P < .01) and 1.9 fewer symptom nights per month (SD = 0.35; P < .01) than did the comparison group. The relative risk in the past year associated with the intervention was 0.63 (95% confidence interval [CI] = 0.45, 0.89) for an emergency department visit and 0.69 (95% CI = 0.47, 1.01) for hospitalization. Care coordination may improve pediatric asthma symptom control and reduce emergency department visits. Expanding third-party reimbursement for care coordination services may help reduce pediatric asthma disparities.

  9. NASA and Public Libraries: Enhancing STEM Literacy in Underserved Communities

    Science.gov (United States)

    Dusenbery, P.; LaConte, K.; Harold, J. B.; Randall, C.

    2016-12-01

    NASA research programs are helping humanity understand the origin and evolution of galaxies, stars, and planets, and defining the conditions necessary to support life beyond Earth. The Space Science Institute's (SSI) National Center for Interactive Learning (NCIL) was recently funded by NASA`s Science Mission Directorate (SMD) to develop and implement a project called NASA@ My Library: A National Earth and Space Science Initiative That Connects NASA, Public Libraries and Their Communities. As places that offer their services for free, public libraries have become the "public square" by providing a place where members of a community can gather for information, educational programming, and policy discussions. Libraries are developing new ways to engage their patrons in STEM learning, and NCIL's STAR Library Education Network (STAR_Net) has been supporting their efforts for the last eight years, including through a vibrant community of practice that serves both librarians and STEM professionals. Project stakeholders include public library staff, state libraries, the earth and space science education community at NASA, subject matter experts, and informal science educators. The project will leverage high-impact SMD and library events to catalyze partnerships through dissemination of SMD assets and professional development. It will also develop frameworks for public libraries to increase STEM interest pathways in their communities (with supports for reaching underserved audiences). This presentation will summarize the key activities and expected outcomes of the 5-year project.

  10. Web usability testing with a Hispanic medically underserved population.

    Science.gov (United States)

    Moore, Mary; Bias, Randolph G; Prentice, Katherine; Fletcher, Robin; Vaughn, Terry

    2009-04-01

    Skilled website developers value usability testing to assure user needs are met. When the target audience differs substantially from the developers, it becomes essential to tailor both design and evaluation methods. In this study, researchers carried out a multifaceted usability evaluation of a website (Healthy Texas) designed for Hispanic audiences with lower computer literacy and lower health literacy. METHODS INCLUDED: (1) heuristic evaluation by a usability engineer, (2) remote end-user testing using WebEx software; and (3) face-to-face testing in a community center where use of the website was likely. Researchers found standard usability testing methods needed to be modified to provide interpreters, increased flexibility for time on task, presence of a trusted intermediary such as a librarian, and accommodation for family members who accompanied participants. Participants offered recommendations for website redesign, including simplified language, engaging and relevant graphics, culturally relevant examples, and clear navigation. User-centered design is especially important when website developers are not representative of the target audience. Failure to conduct appropriate usability testing with a representative audience can substantially reduce use and value of the website. This thorough course of usability testing identified improvements that benefit all users but become crucial when trying to reach an underserved audience.

  11. Smartphone threshold audiometry in underserved primary health-care contexts.

    Science.gov (United States)

    Sandström, Josefin; Swanepoel, De Wet; Carel Myburgh, Hermanus; Laurent, Claude

    2016-01-01

    To validate a calibrated smartphone-based hearing test in a sound booth environment and in primary health-care clinics. A repeated-measure within-subject study design was employed whereby air-conduction hearing thresholds determined by smartphone-based audiometry was compared to conventional audiometry in a sound booth and a primary health-care clinic environment. A total of 94 subjects (mean age 41 years ± 17.6 SD and range 18-88; 64% female) were assessed of whom 64 were tested in the sound booth and 30 within primary health-care clinics without a booth. In the sound booth 63.4% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dB HL corresponded to smartphone thresholds within ≤10 dB in 80.6% of cases with an average threshold difference of -1.6 dB ± 9.9 SD. In primary health-care clinics 13.7% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dBHL corresponded to smartphone thresholds within ≤10 dB in 92.9% of cases with an average threshold difference of -1.0 dB ± 7.1 SD. Accurate air-conduction audiometry can be conducted in a sound booth and without a sound booth in an underserved community health-care clinic using a smartphone.

  12. Engaging diverse underserved communities to bridge the mammography divide

    Directory of Open Access Journals (Sweden)

    Cully Angelia

    2011-01-01

    Full Text Available Abstract Background Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations. Methods/Design In the proposed program, community health workers will meet with rural-dwelling Latina and American Indian women one-on-one to educate them about breast cancer and screening and guide them through a computerized and culturally tailored "implementation intentions" program, called Healthy Living Kansas - Breast Health, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and be randomized to either a mammography "implementation intentions" (MI2 intervention or a

  13. Individual Breast Cancer risk assessment in Underserved Populations: Integrating empirical Bioethics and Health Disparities Research

    Science.gov (United States)

    Anderson, Emily E.; Hoskins, Kent

    2013-01-01

    Research suggests that individual breast cancer risk assessment may improve adherence to recommended screening and prevention guidelines, thereby decreasing morbidity and mortality. Further research on the use of risk assessment models in underserved minority populations is critical to informing national public health efforts to eliminate breast cancer disparities. However, implementing individual breast cancer risk assessment in underserved patient populations raises particular ethical issues that require further examination. After reviewing these issues, we will discuss how empirical bioethics research can be integrated with health disparities research to inform the translation of research findings. Our in-progress National Cancer Institute (NCI) funded study, How Do Underserved Minority Women Think About Breast Cancer?, conducted in the context of a larger study on individual breast cancer risk assessment, is presented as a model. PMID:23124498

  14. Factors associated with differential uptake of seasonal influenza immunizations among underserved communities during the 2009-2010 influenza season.

    Science.gov (United States)

    Vlahov, David; Bond, Keosha T; Jones, Kandice C; Ompad, Danielle C

    2012-04-01

    Influenza vaccination coverage remains low and disparities persist. In New York City, a community-based participatory research project (Project VIVA) worked to address this issue in Harlem and the South Bronx by supplementing existing vaccination programs with non-traditional venues (i.e., community-based organizations). We conducted a 10 min survey to assess access to influenza vaccine as well as attitudes and beliefs towards influenza vaccination that could inform intervention development for subsequent seasons. Among 991 participants recruited using street intercept techniques, 63% received seasonal vaccine only, 11% seasonal and H1N1, and 26% neither; 89% reported seeing a health care provider (HCP) during the influenza season. Correlates of immunization among those with provider visits during the influenza season included being US-born, interest in getting the vaccine, concern about self or family getting influenza, an HCP's recommendation and comfort with government. Among those without an HCP visit, factors associated with immunization included being US born, married, interest in getting the vaccine, understanding influenza information, and concern about getting influenza. Factors associated with lack of interest in influenza vaccine included being born outside the US, Black and uncomfortable with government. In medically underserved areas, having access to routine medical care and understanding the medical implications of influenza play an important role in enhancing uptake of seasonal influenza vaccination. Strategies to improve vaccination rates among Blacks and foreign-born residents need to be addressed. The use of non-traditional venues to provide influenza vaccinations in underserved communities has the potential to reduce health disparities.

  15. American Dental Association White Paper Targets Dental Care for the Underserved

    Science.gov (United States)

    Berthold, Mark

    2005-01-01

    Reaffirming its leadership role toward better oral health for all Americans, the ADA has produced a white paper that also challenges policy-makers and the US to improve access to dental services. The white paper, "State and Community Models for Improving Access to Dental Care for the Underserved," was presented October 1 to the House of…

  16. The Quick Peek Program: A Model for Developmental Screening within Underserved Communities

    Science.gov (United States)

    Harris, Jill; Norton, Amy

    2016-01-01

    Developmental screening of young children is important in all populations, especially underserved communities with known health care disparities. The American Academy of Pediatrics created guidelines and a toolkit for pediatricians to conduct developmental surveillance and screening, yet these guidelines are not uniformly implemented within…

  17. How to Guide: Aggregate under-served markets into buying pools

    Energy Technology Data Exchange (ETDEWEB)

    None

    2000-12-26

    This activity promotes new opportunities to increase energy security and lower energy costs for under-served markets. It involves market analysis and collaboration with community partners, as well as outreach activities to inform target markets and technical assistance for participants.

  18. Investigating the Factors of Resiliency among Exceptional Youth Living in Rural Underserved Communities

    Science.gov (United States)

    Curtin, Kevin A.; Schweitzer, Ashley; Tuxbury, Kristen; D'Aoust, Janelle A.

    2016-01-01

    Resilience is an important social justice concept that has important implications for educators working with exceptional youth in rural underserved communities who may suffer from the consequences associated with economic hardships. This multi-school qualitative study examined resilience among exceptional youth living in rural poverty through the…

  19. Promising Practices: A Literature Review of Technology Use by Underserved Students

    Science.gov (United States)

    Zielezinski, Molly B.; Darling-Hammond, Linda

    2016-01-01

    How can technologies and digital learning experiences be used to support underserved, under-resourced, and underprepared students? For many years, educators, researchers, and policy makers looking for strategies to close the achievement gap and improve student learning have sought solutions involving new uses of technology, especially for students…

  20. A Smart Partnership: Integrating Educational Technology for Underserved Children in India

    Science.gov (United States)

    Charania, Amina; Davis, Niki

    2016-01-01

    This paper explores the evolution of a large multi-stakeholder partnership that has grown since 2011 to scale deep engagement with learning through technology and decrease the digital divide for thousands of underserved school children in India. Using as its basis a case study of an initiative called integrated approach to technology in education…

  1. Breaking Barriers to Bike Share: Insights from Residents of Traditionally Underserved Neighborhoods

    Science.gov (United States)

    2017-06-01

    Evidence has shown that higher income and white populations are overrepresented in both access to and use of bike share. Efforts to overcome underserved communities barriers to access and use of bike share have been initiated in a number of cities...

  2. Using Social Cognitive Theory to Predict Physical Activity and Fitness in Underserved Middle School Children

    Science.gov (United States)

    Martin, Jeffrey J.; McCaughtry, Nate; Flory, Sara; Murphy, Anne; Wisdom, Kimberlydawn

    2011-01-01

    Few researchers have used social cognitive theory and environment-based constructs to predict physical activity (PA) and fitness in underserved middle-school children. Hence, we evaluated social cognitive variables and perceptions of the school environment to predict PA and fitness in middle school children (N = 506, ages 10-14 years). Using…

  3. Rural Health, Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA). Addendum

    Science.gov (United States)

    2010-07-01

    Plaque *c. Pulpitis or an abscess d. Gingivitis 4. Pulp necrosis can be defined as: a. A viral infection in the gums *b. Death of the pulp...families. Available data indicate higher incidences of breast and prostate cancer affecting U.S. military versus the general population (Zhu et al...Meyerowitz, B. E., et al. (2006). Fatigue in long-term breast carcinoma survivors: A longitudinal investigation. Cancer, 106(4), 751-758. Courneya, K

  4. Mobile colposcopy in urban and underserved suburban areas in Baja California

    Science.gov (United States)

    Madiedo, Marta; Contreras, Sonia; Villalobos, Octavio; Kahn, Bruce S.; Safir, Amit; Levitz, David

    2016-03-01

    Cervical cancer is the leading cause of cancer death for women in low resource settings, often affecting the most economically disenfranchised segment of the population. The key challenge with cervical cancer is the lack of an effective screening program for many of the at-risk, difficult-to-reach women. Outreach programs that utilize mobile clinics to increase access to screening and care in Baja California have been developed. However, many barriers such as quality assurance, efficient referral remained a challenge in this region. Visualization-based co-tests together with cytology (Pap smears) as a primary screen have been proposed. Here, the mobile colposcope of the enhanced visual assessment (EVA) is used to capture an image immediately following a Pap smear. EVA images were reviewed by expert colposcopists. Initial or preliminary data from pilot services showed that Pap false positives and Pap false negatives maybe reduced by expert review of EVA images. This suggests that reviewing of EVA images may be instrumental in catching inaccurate Pap results, thereby improving care. Thus, there is a need to further explore the benefits of using EVA as additional information when conducting Pap smear screenings.

  5. Rural Health, Center of Excellence for Remote and Medically Under-served Area (CERMUSA)

    Science.gov (United States)

    2007-05-01

    Curriculum: Foundations, principles, and issues. Needham Heights, MA: Allyn and Bacon. Taylor, R. (2002). Pros and cons of online learning: A...Online 11/9 • 7. Preparation For Final Assignment • 7.1. Conducting a SWOT Analysis - Online 11/16 8. Ne class -Thanksgiving 11/23 9. O~en

  6. 75 FR 26167 - Designation of Medically Underserved Populations and Health Professions Shortage Areas; Intent To...

    Science.gov (United States)

    2010-05-11

    ...) representing a range of States in terms of size, rural/urban, and different regions of the country, including... unusually high needs, as indicated by high poverty, infant mortality or fertility rates, overutilization, or... being: percent of the population with incomes below the poverty level; primary care physician-to...

  7. Nurse Education, Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA)

    Science.gov (United States)

    2013-10-01

    for the clinical managemen t of all ages and populations affected by disasters and public health emergencies , in accordance with...Essential VII, Objective 9 8.0 Demonstrate knowledge of public health principles and practices for the managemen t of all ages and...Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204

  8. Center of Excellence for Remote and Medically Under-Served Areas

    Science.gov (United States)

    2008-04-11

    healthcare projects. Telemedicine is not the sole cure for the rural health dilemma; it can be a major ingredient if aggressively deployed. Providers can...effects of this course curriculum on student health will be evidenced in BMI changes, absentee rates, and number of visits to the school nurse...ninth grade students will result in improved health as evidenced by prevention of weight gain, decreased absenteeism , and decreased number of

  9. Remote Patient Management in a Mammographic Screening Environment in Underserved Areas

    Science.gov (United States)

    2005-09-01

    of 4,945 paired examinations. Radiology 2001; 218:873-880. 10. Malich A, Marx C, Facius M, Boehm T, Fleck M, Kaiser WA. Tumour 24. Venta LA, Hendrick...218:873-880. KF, Sickles EA. Mammographic character- factor determining the quality of com- 15. Venta LA, Hendrick RE, Adler YT, et al. iSicks of 115

  10. Self-collected cervicovaginal sampling for site-of-care primary HPV-based cervical cancer screening: a pilot study in a rural underserved Greek population.

    Science.gov (United States)

    Chatzistamatiou, Kimon; Chatzaki, Εkaterini; Constantinidis, Τheocharis; Nena, Evangelia; Tsertanidou, Athena; Agorastos, Theodoros

    2017-11-01

    In the present pilot study, the feasibility of a site-of-care cervicovaginal self-sampling methodology for HPV-based screening was tested in 346 women residing in underserved rural areas of Northern Greece. These women provided self-collected cervicovaginal sample along with a study questionnaire. Following molecular testing, using the cobas ® HPV Test, Roche ® , HPV positive women, were referred to colposcopy and upon abnormal findings, to biopsy and treatment. Participation rate was 100%. Regular pap-test examination was reported for 17.1%. Among hrHPV testing, 11.9% were positive and colposcopy/biopsy revealed 2 CIN3 cases. Non-compliance was the most prevalent reason for no previous attendance. Most women reported non-difficulty and non-discomfort in self-sampling (77.6% and 82.4%, respectively). They would choose self-sampling over clinician-sampling (86.2%), and should self-sampling being available, they would test themselves more regularly (92.3%). In conclusion, self-sampling is feasible and well-accepted for HPV-based screening, and could increase population coverage in underserved areas, helping towards successful prevention.

  11. Disseminating relevant health information to underserved audiences: implications of the Digital Divide Pilot Projects*

    Science.gov (United States)

    Kreps, Gary L.

    2005-01-01

    Objective: This paper examines the influence of the digital divide on disparities in health outcomes for vulnerable populations, identifying implications for medical and public libraries. Method: The paper describes the results of the Digital Divide Pilot Projects demonstration research programs funded by the National Cancer Institute to test new strategies for disseminating relevant health information to underserved and at-risk audiences. Results: The Digital Divide Pilot Projects field-tested innovative systemic strategies for helping underserved populations access and utilize relevant health information to make informed health-related decisions about seeking appropriate health care and support, resisting avoidable and significant health risks, and promoting their own health. Implications: The paper builds on the Digital Divide Pilot Projects by identifying implications for developing health communication strategies that libraries can adopt to provide digital health information to vulnerable populations. PMID:16239960

  12. Disseminating relevant health information to underserved audiences: implications of the Digital Divide Pilot Projects.

    Science.gov (United States)

    Kreps, Gary L

    2005-10-01

    This paper examines the influence of the digital divide on disparities in health outcomes for vulnerable populations, identifying implications for medical and public libraries. The paper describes the results of the Digital Divide Pilot Projects demonstration research programs funded by the National Cancer Institute to test new strategies for disseminating relevant health information to underserved and at-risk audiences. The Digital Divide Pilot Projects field-tested innovative systemic strategies for helping underserved populations access and utilize relevant health information to make informed health-related decisions about seeking appropriate health care and support, resisting avoidable and significant health risks, and promoting their own health. The paper builds on the Digital Divide Pilot Projects by identifying implications for developing health communication strategies that libraries can adopt to provide digital health information to vulnerable populations.

  13. Effects of dance on depression, physical function, and disability in underserved adults.

    Science.gov (United States)

    Murrock, Carolyn J; Graor, Christine Heifner

    2014-07-01

    This study documented the feasibility and immediate effects of a dance intervention two times per week for 12 weeks on depression, physical function, and disability in older, underserved adults. The one-group, pretest-posttest study had a convenience sample of 40 participants recruited from a federally subsidized apartment complex located in an economically depressed, inner-city neighborhood. Depression, physical function, and disability were measured at baseline and 12 weeks. Average age was 63 years (SD = 7.9), 92% were female, and 75% were African American. At baseline, participants reported increased depression (M = 20.0, SD = 12.4), decreased physical function (M = 56.6, SD = 10.9), and increased disability limitations (M = 65.7, SD = 14.9). At posttest, paired t tests showed that the dance intervention significantly decreased depression, t = 6.11, p dance intervention may be an effective adjunct therapy to improve depression, disability, and physical function in underserved adults.

  14. Knowledgeable Neighbors: a mobile clinic model for disease prevention and screening in underserved communities.

    Science.gov (United States)

    Hill, Caterina; Zurakowski, David; Bennet, Jennifer; Walker-White, Rainelle; Osman, Jamie L; Quarles, Aaron; Oriol, Nancy

    2012-03-01

    The Family Van mobile health clinic uses a "Knowledgeable Neighbor" model to deliver cost-effective screening and prevention activities in underserved neighborhoods in Boston, MA. We have described the Knowledgeable Neighbor model and used operational data collected from 2006 to 2009 to evaluate the service. The Family Van successfully reached mainly minority low-income men and women. Of the clients screened, 60% had previously undetected elevated blood pressure, 14% had previously undetected elevated blood glucose, and 38% had previously undetected elevated total cholesterol. This represents an important model for reaching underserved communities to deliver proven cost-effective prevention activities, both to help control health care costs and to reduce health disparities.

  15. Personal values of family physicians, practice satisfaction, and service to the underserved.

    Science.gov (United States)

    Eliason, B C; Guse, C; Gottlieb, M S

    2000-03-01

    Personal values are defined as "desirable goals varying in importance that serve as guiding principles in people's lives," and have been shown to influence specialty choice and relate to practice satisfaction. We wished to examine further the relationship of personal values to practice satisfaction and also to a physician's willingness to care for the underserved. We also wished to study associations that might exist among personal values, practice satisfaction, and a variety of practice characteristics. We randomly surveyed a stratified probability sample of 1224 practicing family physicians about their personal values (using the Schwartz values questionnaire), practice satisfaction, practice location, breadth of practice, demographics, board certification status, teaching involvement, and the payor mix of the practice. Family physicians rated the benevolence (motivation to help those close to you) value type highest, and the ratings of the benevolence value type were positively associated with practice satisfaction (correlation coefficient = 0.14, P = .002). Those involved in teaching medical trainees were more satisfied than those who were not involved (P = .009). Some value-type ratings were found to be positively associated with caring for the underserved. Those whose practices consisted of more than 40% underserved (underserved defined as Medicare, Medicaid, and indigent populations) rated the tradition (motivation to maintain customs of traditional culture and religion) value type significantly higher (P = .02). Those whose practices consisted of more than 30% indigent care rated the universalism (motivation to enhance and protect the well-being of all people) value type significantly higher (P = .03). Family physicians who viewed benevolence as a guiding principle in their lives reported a higher level of professional satisfaction. Likewise, physicians involved in the teaching of medical trainees were more satisfied with their profession. Family physicians

  16. Designing for Underserved Populations: Constraints and Requirements of Personal Health Record Systems

    Centers for Disease Control (CDC) Podcasts

    2009-02-11

    In this podcast, Dr. Thomas Horan discusses how language, literacy, and access barriers can be overcome with electronic Personal Health Record (PHR) systems to improve health among the most vulnerable, isolated, and underserved populations.  Created: 2/11/2009 by Coordinating Center for Health Information Service (CCHIS), Healthy Healthcare Settings Goal Team, Office of Strategy and Innovation.   Date Released: 9/2/2009.

  17. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol

    OpenAIRE

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-01-01

    Introduction The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. Methods and analysis This systematic review addresses the following question: in underserviced populations and low-reso...

  18. Physician assistants as servant leaders: meeting the needs of the underserved.

    Science.gov (United States)

    Huckabee, Michael J; Wheeler, Daniel W

    2011-01-01

    The purpose of this study was to determine if the level of servant leader characteristics in clinically practicing physician assistants (PAs) in underserved populations differed from PAs serving in other locales. Five subscales of servant leadership: altruistic calling, emotional healing, wisdom, persuasive mapping, and organizational stewardship, were measured in a quantitative study of clinically practicing PAs using a self-rating survey and a similar survey by others rating the PA. Of 777 PAs invited, 321 completed the survey. On a scale of 1 to 5, mean PA self-ratings ranged from 3.52 (persuasive mapping) to 4.05 (wisdom). Other raters' scores paired with the self-rated PA scores were comparable in all subscales except wisdom, which was rated higher by the other raters (4.32 by other raters, 4.01 by PAs, P= .002). There was no significant difference in the measures of servant leadership reported by PAs serving the underserved compared to PAs serving in other populations. Servant leader subscales were higher for PAs compared to previous studies of other health care or community leader populations. The results found that the PA population studied had a prominent level of servant leadership characteristics that did not differ between those working with underserved and nonunderserved populations.

  19. Intrinsic rewards experienced by a group of dentists working with underserved populations.

    Science.gov (United States)

    Gardner, S P; Roberts-Thomson, K F; Winning, T A; Peterson, R

    2014-09-01

    The aim of this study was to explore, using qualitative methods, the intrinsic reasons why dentists work with underserved groups. Minority and marginalized groups of Australians suffer a greater burden of dental disease than the general population due to disparities in accessing care. Recruitment and retention of dentists to care for underserved groups is problematic due to personal, professional and structural reasons. What drives dentists to work with underserved groups is not widely known. Sixteen dentists were recruited using 'snowball' purposeful sampling. Semi-structured in-depth interviews were conducted. Thematic analysis was conducted on the transcriptions to identify themes. Five key themes emerged: (1) 'tapped on the shoulder', being personally approached or invited; (2) 'dental school experience', the challenges faced as a student; (3) 'empathic concern', the non-judgemental expressions of care toward others; (4) 'resilience', the ability to bounce back after setbacks; (5) 'intrinsic reward', the personal gain and satisfaction received. This study focuses on the intrinsic rewards which were found to be simple, unexpected, and associated with relieving pain, community engagement and making a difference. Emphasizing personal fulfilment and intrinsic reward could be useful when promoting dentistry as a career and when encouraging graduates to consider working with disadvantaged groups. © 2014 Australian Dental Association.

  20. A psychosocial approach to dentistry for the underserved: incorporating theory into practice.

    Science.gov (United States)

    Flaer, Paul J; Younis, Mustafa Z; Benjamin, Paul L; Al Hajeri, Maha

    2010-01-01

    Dentistry for the underserved is more than an egalitarian social issue--it is a key factor in the health and social progress of our nation. The first signs or manifestations of several diseases such as varicella (i.e., chicken pox and shingles), STDs, and influenza become apparent in the oral cavity. The value of access to quality dentistry is an immeasurable factor in maintaining general medical health of people and fulfilling their psychosocial needs of pain reduction and enhanced cosmetics. In the United States, for the most part, only the middle and upper classes receive non-extraction, restorative, and prosthetic dentistry that is economically within their ability to pay. In addition, uninsured and poverty-level individuals often must face overwhelming long waiting lists, unnecessary referrals, lack of choice, and bureaucratic hurdles when seeking primary dental care. Therefore, it seems pertinent to put forth the question: What are the critical values and beliefs of psychosocial theory that can underscore the practice of dentistry for underserved populations in the United States? The widely employed public health theory, the health belief model (HBM), is applied to evaluate psychosocial factors in dental care for the underserved. The HBM is used to predict and explain behavioral changes in dental health and associated belief patterns. The HBM as applied to dentistry for the underserved predicts self-perceptions of susceptibility and seriousness of dental disease, health status, cues to action, and self-efficacy. Furthermore, patients can make judgments about benefits, costs, and risks of dental treatment. A theoretical approach to dentistry employing the HBM, mediated by values and culture, can provide significant insights into patient thinking, beliefs, and perceptions. These insights can mediate access to and use of primary care dental services by underserved populations. Evidence-based practice (i.e., based on research using the scientific method) has been

  1. Behavioral economics: "nudging" underserved populations to be screened for cancer.

    Science.gov (United States)

    Purnell, Jason Q; Thompson, Tess; Kreuter, Matthew W; McBride, Timothy D

    2015-01-15

    Persistent disparities in cancer screening by race/ethnicity and socioeconomic status require innovative prevention tools and techniques. Behavioral economics provides tools to potentially reduce disparities by informing strategies and systems to increase prevention of breast, cervical, and colorectal cancers. With an emphasis on the predictable, but sometimes flawed, mental shortcuts (heuristics) people use to make decisions, behavioral economics offers insights that practitioners can use to enhance evidence-based cancer screening interventions that rely on judgments about the probability of developing and detecting cancer, decisions about competing screening options, and the optimal presentation of complex choices (choice architecture). In the area of judgment, we describe ways practitioners can use the availability and representativeness of heuristics and the tendency toward unrealistic optimism to increase perceptions of risk and highlight benefits of screening. We describe how several behavioral economic principles involved in decision-making can influence screening attitudes, including how framing and context effects can be manipulated to highlight personally salient features of cancer screening tests. Finally, we offer suggestions about ways practitioners can apply principles related to choice architecture to health care systems in which cancer screening takes place. These recommendations include the use of incentives to increase screening, introduction of default options, appropriate feedback throughout the decision-making and behavior completion process, and clear presentation of complex choices, particularly in the context of colorectal cancer screening. We conclude by noting gaps in knowledge and propose future research questions to guide this promising area of research and practice.

  2. Meeting the Needs of Underserved Patients in Western Kenya by Creating the Next Generation of Global Health Pharmacists.

    Science.gov (United States)

    Miller, Monica L; Karwa, Rakhi; Schellhase, Ellen M; Pastakia, Sonak D; Crowe, Susie; Manji, Imran; Jakait, Beatrice; Maina, Mercy

    2016-03-25

    Objective. To describe a novel training model used to create a sustainable public health-focused pharmacy residency based in Kenya and to describe the outcomes of this training program on underserved populations. Design. The postgraduate year 2 residency was designed to expose trainees to the unique public health facets of inpatient, outpatient, and community-based care delivery in low and middle-income countries. Public health areas of focus included supply chain management, reproductive health, pediatrics, HIV, chronic disease management, and teaching. Assessment. The outcomes of the residency were assessed based on the number of new clinical programs developed by residents, articles and abstracts written by residents, and resident participation in grant writing. To date, six residents from the United States and eight Kenyan residents have completed the residency. Eleven sustainable patient care services have been implemented as a result of the residency program. Conclusion. This pharmacy residency training model developed accomplished pharmacists in public health pharmacy, with each residency class expanding funding and clinical programming, contributing to curriculum development, and creating jobs.

  3. Liability concerns and shared use of school recreational facilities in underserved communities.

    Science.gov (United States)

    Spengler, John O; Connaughton, Daniel P; Maddock, Jason E

    2011-10-01

    In underserved communities, schools can provide the physical structure and facilities for informal and formal recreation as well as after-school, weekend, and summer programming. The importance of community access to schools is acknowledged by authoritative groups; however, fear of liability is believed to be a key barrier to community access. The purpose of this study was to investigate perceptions of liability risk and associated issues among school administrators in underserved communities. A national survey of school administrators in underserved communities (n=360, response rate of 21%) was conducted in 2009 and analyzed in 2010. Liability perceptions in the context of community access were assessed through descriptive statistics. The majority of respondents (82.2%) indicated concern for liability should someone be injured on school property after hours while participating in a recreational activity. Among those that did not allow community access, 91% were somewhat to very concerned about liability and 86% believed that stronger legislation was needed to better protect schools from liability for after-hours recreational use. Among those who claimed familiarity with a state law that offered them limited liability protection, nearly three fourths were nevertheless concerned about liability. Liability concerns are prevalent among this group of school administrators, particularly if they had been involved in prior litigation, and even if they indicated they were aware of laws that provide liability protection where use occurs after hours. Reducing these concerns will be important if schools are to become locations for recreational programs that promote physical activity outside of regular school hours. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Factors influencing participation in worksite wellness programs among minority and underserved populations.

    Science.gov (United States)

    Thompson, Sharon E; Smith, Brenda A; Bybee, Ronald F

    2005-01-01

    In the United States, employers and employees are increasingly paying a larger portion of the nation's healthcare bill. Preventive measures are being employed by businesses in an effort to contain the escalating costs of employee healthcare. The work site is an ideal setting for health promotion because 130 million Americans are employed and spend one third of their time at work. However, unhealthy workers tend to be the least likely to participate in health promotion activities. Worksite Wellness Programs must be designed to engage segments of the work force with the greatest health needs. Culturally sensitive and appropriate programs must be developed to engage economically challenged minority and other underserved populations.

  5. Neighborhood Social Predictors of Weight-related Measures in Underserved African Americans in the PATH Trial.

    Science.gov (United States)

    McDaniel, Tyler C; Wilson, Dawn K; Coulon, Sandra M; Hand, Gregory A; Siceloff, E Rebekah

    2015-11-05

    African Americans have the highest rate of obesity in the United States relative to other ethnic minority groups. Bioecological factors including neighborhood social and physical environmental variables may be important predictors of weight-related measures specifically body mass index (BMI) in African American adults. Baseline data from the Positive Action for Today's Health (PATH) trial were collected from 417 African American adults. Overall a multiple regression model for BMI was significant, showing positive associations with average daily moderate-to-vigorous physical activity (MVPA) (B =-.21, Psocial interaction (B =-.13, Psocial interaction was associated with healthier BMI, highlighting it as a potential critical factor for future interventions in underserved, African American communities.

  6. Weight status as a moderator of the relationship between motivation, emotional social support, and physical activity in underserved adolescents.

    Science.gov (United States)

    St George, Sara M; Wilson, Dawn K; Lawman, Hannah G; Van Horn, M Lee

    2013-05-01

    This study examined weight status as a moderator of the relationship between motivation (controlled, autonomous, regulatory), emotional social support (parents, peers) and moderate-to-vigorous physical activity (MVPA) in underserved adolescents (ethnic minority, low-income). Participants from the Active by Choice Today Trial (n = 1,416; 54% girls, 73% African American, 52% overweight/obese) completed baseline measures, including height and weight, psychosocial surveys, and 7-day accelerometry estimates. Weight status was defined by body mass index z-score (zBMI). Weight status moderated the effects of controlled, autonomous, and regulatory motivation on MVPA, such that these variables were more strongly associated with MVPA in adolescents with lower versus higher zBMI scores. A better understanding of why motivation is not related to MVPA in underserved youth with a higher weight status is needed. Future pediatric obesity treatment in underserved youth may need to move beyond motivation into environmental factors associated with long-term behavior change.

  7. Randomized Trial of a Family-based, Automated, Conversational Obesity Treatment Program for Underserved Populations

    Science.gov (United States)

    Wright, J. A.; Phillips, B.D.; Watson, B.L.; Newby, P.K.; Norman, G. J.; Adams, W.G.

    2013-01-01

    Objective To evaluate the acceptability and feasibility of a scalable obesity treatment program integrated with pediatric primary care and delivered using interactive voice technology (IVR) to families from underserved populations. Design and Methods Fifty parent-child dyads (child 9–12 yrs, BMI >95th percentile) were recruited from a pediatric primary care clinic and randomized to either an IVR or a wait-list control (WLC) group. The majority were lower-income, African-American (72%) families. Dyads received IVR calls for 12 weeks. Call content was informed by two evidenced-based interventions. Anthropometric and behavioral variables were assessed at baseline and 3 mo follow-up. Results Forty-three dyads completed the study. IVR parents ate 1 cup more fruit than WLC (p 75% agreed that the calls were useful, made for people like them, credible, and helped them eat healthy foods. Conclusion An obesity treatment program delivered via IVR may be an acceptable and feasible resource for families from underserved populations. PMID:23512915

  8. Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients.

    Science.gov (United States)

    Seo, Joann; Goodman, Melody S; Politi, Mary; Blanchard, Melvin; Kaphingst, Kimberly A

    2016-05-01

    Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population. We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician directed or patient involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association. Adequate health literacy (odds ratio [OR] = 1.7;P= 0.009) was significantly associated with preferring patient-involved decision making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision making (OR = 0.65;P= 0.024). Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy. © The Author(s) 2016.

  9. Employing Young Talent from Underserved Populations: Designing a Flexible Organizational Process for Assimilation and Productivity

    Directory of Open Access Journals (Sweden)

    Arthur Mark Langer

    2013-04-01

    Full Text Available This article describes an ongoing 13-year-old program designed to improve the ability of organizations to assimilate young talent from underserved populations, mostly students who have recently graduated from high school. Although many firms have internship and orientation programs, few have well-tested organizational approaches for assimilating 17-20 year-olds into their organizations in an efficient and productive manner. The objective of this study is to describe and evaluate the solution introduced by Workforce Opportunity Services (WOS, a non-profit agency that provides organizations with well-trained talent from underserved local communities. The WOS model is a systemic design involving a lead agency (WOS, corporate clients, training partnerships with local colleges and universities, and underutilized human capital. Over 290 students have completed the WOS program and obtained long-term employment, mostly in IT jobs that normally are outsourced. The results of the study show that companies have success employing young talent when they follow the WOS organizational process. Companies need to have patience with WOS student employees, but within six months most members of the WOS program make positive contributions to their sponsoring firm and have a strong likelihood of becoming permanently employed. Implications of the WOS model for organization design are discussed.

  10. Improving cardiovascular health of underserved populations in the community with Life's Simple 7.

    Science.gov (United States)

    Murphy, Marcia Pencak; Coke, Lola; Staffileno, Beth A; Robinson, Janis D; Tillotson, Robin

    2015-11-01

    The purpose of this nurse practitioner (NP) led initiative was to improve the cardiovascular health of two underserved populations in the community using the American Heart Association (AHA) Life's Simple 7 and My Life Check (MLC) tools. Two inner city community sites were targeted: (a) a senior center servicing African American (AA) older adults, and (b) a residential facility servicing homeless women. Preprogram health data (blood pressure, cholesterol, blood glucose levels, body mass index, and health behaviors) were collected to calculate MLC scores. Postprogram health data were obtained on participants with the lowest MLC scores who completed the program. Eight older adults completed the program with a 37.1% increase in average MLC score (6.2 vs. 8.5). Ten women completed the program with a 9.3% decrease in average MLC score (4.3 vs. 3.9). Favorable benefits were observed in the AA older adults. In contrast, similar benefits were not observed in the women, which may be because of a constellation of social, environmental, biological, and mental health factors. NPs are prepared to target community-based settings to address the health of underserved populations. Engaging key stakeholders in the planning and implementation is essential for success. ©2015 American Association of Nurse Practitioners.

  11. Impact of Patient Empathy Modeling on Pharmacy Students Caring for the Underserved

    Science.gov (United States)

    Chen, Judy T.; LaLopa, Joseph

    2008-01-01

    Objective To determine the impact of the Patient Empathy Modeling pedagogy on students' empathy towards caring for the underserved during an advanced pharmacy practice experience (APPE). Design Pharmacy students completing an APPE at 2 primary care clinics participated in a Patient Empathy Modeling assignment for 10 days. Each student “became the patient,” simulating the life of an actual patient with multiple chronic diseases who was coping with an economic, cultural, or communication barrier to optimal healthcare. Students completed the Jefferson Scale of Physician Empathy (JSPE) before and after completing the assignment, and wrote daily journal entries and a reflection paper. Assessment Twenty-six students completed the PEM exercises from 2005-2006. Scores on the JSPE improved. Students' comments in journals and reflection papers revealed 3 major themes: greater appreciation of the difficulty patients have with adherence to medication and treatment regimens, increased empathy for patients from different backgrounds and patients with medical and psychosocial challenges, and improved ability to apply the lessons learned in the course to their patient care roles. Conclusion A Patient Empathy Modeling assignment improved pharmacy students' empathy toward underserved populations. Integrating the assignment within an APPE allowed students to immediately begin applying the knowledge and insight gained from the exercise. PMID:18483606

  12. Multicultural Milky Way: Ethnoastronomy and Planetarium Shows for Under-served Arizonans

    Science.gov (United States)

    Knierman, Karen

    2018-01-01

    The astronomy outreach initiative, Multicultural Milky Way, partners the School of Earth and Space Exploration (SESE) at Arizona State University (ASU) with under-served populations in Arizona in learning about our Milky Way and other galaxies. Arizona is home to many diverse populations with rich cultural histories such as Mayan, Navajo, and Apache. Linking astronomy practiced by one’s indigenous culture to that of Western astronomy may increase the interest in science. Through multicultural planetarium shows and associated hands-on activities, under-served students and families will learn how the Milky Way is represented in different cultures and about the science of galaxies. New planetarium shows using the Mesa Community College (MCC) Digital Planetarium and STARLAB portable planetarium explore how the Milky Way is interpreted in different cultures. STARLAB shows and associated new hands-on activities have been featured during school visits, teacher trainings, and Community Astronomy Nights around Arizona. For authentic assessment, evaluation techniques and procedures were developed.

  13. Practices Caring For The Underserved Are Less Likely To Adopt Medicare's Annual Wellness Visit.

    Science.gov (United States)

    Ganguli, Ishani; Souza, Jeffrey; McWilliams, J Michael; Mehrotra, Ateev

    2018-02-01

    In 2011 Medicare introduced the annual wellness visit to help address the health risks of aging adults. The visit also offers primary care practices an opportunity to generate revenue, and may allow practices in accountable care organizations to attract healthier patients while stabilizing patient-practitioner assignments. However, uptake of the visit has been uneven. Using national Medicare data for the period 2008-15, we assessed practices' ability and motivation to adopt the visit. In 2015, 51.2 percent of practices provided no annual wellness visits (nonadopters), while 23.1 percent provided visits to at least a quarter of their eligible beneficiaries (adopters). Adopters replaced problem-based visits with annual wellness visits and saw increases in primary care revenue. Compared to nonadopters, adopters had more stable patient assignment and a slightly healthier patient mix. At the same time, visit rates were lower among practices caring for underserved populations (for example, racial minorities and those dually enrolled in Medicaid), potentially worsening disparities. Policy makers should consider ways to encourage uptake of the visit or other mechanisms to promote preventive care in underserved populations and the practices that serve them.

  14. Development and pilot evaluation of novel genetic educational materials designed for an underserved patient population.

    Science.gov (United States)

    Lubitz, Rebecca Jean; Komaromy, Miriam; Crawford, Beth; Beattie, Mary; Lee, Robin; Luce, Judith; Ziegler, John

    2007-01-01

    Genetic counseling for BRCA1 and BRCA2 mutations involves teaching about hereditary cancer, genetics and risk, subjects that are difficult to grasp and are routinely misunderstood. Supported by a grant from the Avon Foundation, the UCSF Cancer Risk Program started the first genetic testing and counseling service for a population of traditionally underserved women of varied ethnic and social backgrounds at the San Francisco General Hospital (SFGH). Informed by educational theory and clinical experience, we devised and piloted two simplified explanations of heredity and genetic risk, with the aim of uncovering how to best communicate genetics and risk to this underserved population. A "conventional" version comprised pictures of genes, pedigrees, and quantitative representations of risk. A "colloquial" pictorial version used an analogy of the "information book" of genes, family stories and vignettes, and visual representations of risk, without using scientific words such as genes or chromosomes. A verbal narrative accompanied each picture. We presented these modules to four focus groups of five to eight women recruited from the SFGH Family Practice Clinic. Overall, women preferred a picture-based approach and commented that additional text would have been distracting. The majority of women preferred the colloquial version because it was easier to understand and better conveyed a sense of comfort and hope. We conclude that simplicity, analogies, and familiarity support comprehension while vignettes, family stories, and photos of real people provide comfort and hope. These elements may promote understanding of complex scientific topics in healthcare, particularly when communicating with patients who come from disadvantaged backgrounds.

  15. Sharing Gravity's Microscope: Star Formation and Galaxy Evolution for Underserved Arizonans

    Science.gov (United States)

    Knierman, Karen A.; Monkiewicz, Jacqueline A.; Bowman, Catherine DD; Taylor, Wendy

    2016-01-01

    Learning science in a community is important for children of all levels and especially for many underserved populations. This project combines HST research of galaxy evolution using gravitationally lensed galaxies with hands-on activities and the Starlab portable planetarium to link astronomy with families, teachers, and students. To explore galaxy evolution, new activities were developed and evaluated using novel evaluation techniques. A new set of galaxy classification cards enable inquiry-based learning about galaxy ages, evolution, and gravitational lensing. Activities using new cylinder overlays for the Starlab transparent cylinder will enable the detailed examination of star formation and galaxy evolution as seen from the viewpoint inside of different types of galaxies. These activities were presented in several Arizona venues that enable family and student participation including ASU Earth and Space Open House, Arizona Museum of Natural History Homeschooling Events, on the Salt River Pima-Maricopa Indian Community, and inner city Phoenix schools serving mainly Hispanic populations. Additional events targeted underserved families at the Phoenix Zoo, in Navajo County, and for the Pascua Yaqui Tribe. After evaluation, the activities and materials will also be shared with local teachers and nationally.

  16. Cancer screening promotion among medically underserved Asian American women: integration of research and practice.

    Science.gov (United States)

    Yu, Mei-yu; Seetoo, Amy D; Hong, Oi Saeng; Song, Lixin; Raizade, Rekha; Weller, Adelwisa L Agas

    2002-01-01

    Mammography and Pap smear tests are known to be effective early detection measures for breast and cervical cancers, respectively, but Asian Americans are reluctant to make visits for routine preventive care. Quantitative and qualitative research conducted by the Healthy Asian Americans Project (HAAP) between 1996 and 1999 indicated that Asian residents in southeastern Michigan, like the general Asian population in the US, underutilized early cancer screening programs due to cultural, psychosocial, linguistic, and economic barriers. This article reports how the HAAP's research findings guided the Michigan Breast and Cervical Cancer Control Program (BCCCP) promotion (conducted from 2000 to 2001 among medically underserved Asian women residing in southeastern Michigan), and how evaluation of the HAAP's BCCCP promotion will direct future research and health promotion programs. The article presents strategies used to improve access to cancer screening programs for diverse Asian sub-groups as well as outcomes of the 2-year HAAP's BCCCP promotion among the target population. Discussion regarding lessons and experiences gained from integration of research and practice has implications on design and implementation of the cancer screening promotion for the rapidly increasing Asian American population as well as other medically underserved minority populations in the US.

  17. Experiences, opportunities and challenges of implementing task shifting in underserved remote settings: the case of Kongwa district, central Tanzania

    Directory of Open Access Journals (Sweden)

    Munga Michael A

    2012-11-01

    infrastructures are not in place before formalising tasks shifting. There was also a perception that implementation of task shifting has ensured access to services especially in underserved remote areas. Professional discontent and challenges related to the management of health personnel policies were also perceived as important issues to consider when implementing task shifting practices. Additional resources for additional training and supervisory tasks were also considered important in the implementation of task shifting in order to make it deliver much the same way as it is for conventional modalities of delivering care. Conclusions Task shifting implementation occurs as an ad hoc coping mechanism to the existing shortages of health workers in many undeserved areas of the country, not just in the study site whose findings are reported in this paper. It is recommended that the most important thing to do now is not to determine whether task shifting is possible or effective but to define the limits of task shifting so as to reach a consensus on where it can have the strongest and most sustainable impact in the delivery of quality health services. Any action towards this end needs to be evidence-based.

  18. Interactive web-based portals to improve patient navigation and connect patients with primary care and specialty services in underserved communities.

    Science.gov (United States)

    Highfield, Linda; Ottenweller, Cecelia; Pfanz, Andre; Hanks, Jeanne

    2014-01-01

    This article presents a case study in the redesign, development, and implementation of a web-based healthcare clinic search tool for virtual patient navigation in underserved populations in Texas. It describes the workflow, assessment of system requirements, and design and implementation of two online portals: Project Safety Net and the Breast Health Portal. The primary focus of the study was to demonstrate the use of health information technology for the purpose of bridging the gap between underserved populations and access to healthcare. A combination of interviews and focus groups was used to guide the development process. Interviewees were asked a series of questions about usage, usability, and desired features of the new system. The redeveloped system offers a multitier architecture consisting of data, business, and presentation layers. The technology used in the new portals include Microsoft .NET Framework 3.5, Microsoft SQL Server 2008, Google Maps JavaScript API v3, jQuery, Telerik RadControls (ASP.NET AJAX), and HTML. The redesigned portals have 548 registered clinics, and they have averaged 355 visits per month since their launch in late 2011, with the average user visiting five pages per visit. Usage has remained relatively constant over time, with an average of 142 new users (40 percent) each month. This study demonstrates the successful application of health information technology to improve access to healthcare and the successful adoption of the technology by targeted end users. The portals described in this study could be replicated by health information specialists in other areas of the United States to address disparities in healthcare access.

  19. Effect of Active Videogames on Underserved Children's Classroom Behaviors, Effort, and Fitness.

    Science.gov (United States)

    Gao, Zan; Lee, Jung Eun; Pope, Zachary; Zhang, Dachao

    2016-09-30

    The purpose of this study was to examine the effect of active videogames (AVGs) on underserved minority children's on-task classroom behavior, academic effort, and fitness. A one group pre- and posttest repeated measures design was used. In Fall 2013, 95 fourth grade children (57 boys, 38 girls; 96% of minority) from three classes at an underserved urban elementary school participated in teacher-supervised AVG activities (e.g., Wii Sports, Xbox Just Dance). Specifically, students participated in a 50-minute weekly AVG program at school for 6 weeks. Children's academic effort was evaluated by classroom teachers using a validated scale that assessed activity, attention, conduct, and social/emotional behavior. Moreover, children's classroom behavior was observed immediately before and after each AVG session by trained researchers. Finally, cardiovascular fitness was also measured. A paired t-test was used to assess teacher-rated student effort, while one-way (gender) analysis of variance (ANOVA) with repeated measures was performed to analyze children's on-task classroom behavior. There was a significant effect on children's effort between the first (mean = 3.24, SD = 0.75) and last week (mean = 3.41, SD = 0.73) assessments, t = 2.42, P = 0.02. In addition, there was a significant effect on classroom behavior, F = 33.103, P < 0.01. In detail, children scored significantly higher on on-task behavior during the post-AVG observation (mean = 81.4, SD = 12.3) than seen during the pre-AVG observation (mean = 69.8, SD = 14.9). However, no main effect was indicated for gender, F = 0.39, P = 0.54. No significant improvement in cardiovascular fitness was observed, although slight improvements were seen. Offering an AVG program at school could improve underserved minority children's classroom on-task behavior and academic effort. Future studies may include a control group to further confirm the effectiveness of AVG

  20. Diet and Exercise Adherence and Practices among Medically Underserved Patients with Chronic Disease: Variation across Four Ethnic Groups

    Science.gov (United States)

    Orzech, Kathryn M.; Vivian, James; Huebner Torres, Cristina; Armin, Julie; Shaw, Susan J.

    2013-01-01

    Many factors interact to create barriers to dietary and exercise plan adherence among medically underserved patients with chronic disease, but aspects related to culture and ethnicity are underexamined in the literature. Using both qualitative ("n" = 71) and quantitative ("n" = 297) data collected in a 4-year, multimethod study…

  1. 75 FR 29447 - Public Health Service Act, Rural Physician Training Grant Program, Definition of “Underserved...

    Science.gov (United States)

    2010-05-26

    ..., identified by the Regulatory Information Number (RIN), by any of the following methods: Federal eRulemaking... assisting eligible entities in recruiting students most likely to practice medicine in underserved rural... determined that good cause exists which makes the usual notice and comment procedure impractical, unnecessary...

  2. Navigating the digital divide: A systematic review of eHealth literacy in underserved populations in the United States.

    Science.gov (United States)

    Chesser, Amy; Burke, Anne; Reyes, Jared; Rohrberg, Tessa

    2016-01-01

    eHealth provides an important mechanism to connect medically underserved populations with health information, but little is known about gaps in eHealth literacy research in underserved adult populations within the U.S. Between June and July 2013, three systematic literature reviews of five databases were conducted and a subsequent hand search was completed. Identified literature was screened and studies meeting exclusion and inclusion criteria were synthesized and analyzed for common themes. Of the 221 articles critically appraised, 15 met these criteria. Thirty-five of these studies were excluded due to international origin. Of the articles meeting the inclusion criteria, underserved populations assessed included immigrant women, the elderly, low-income, the un- and underemployed, and African-American and Hispanic populations. eHealth literacy assessments utilized included one or two item screeners, the eHEALS scale, health information competence and cognitive task analysis. Factors examined in relation to eHealth literacy included age, experience, overall health literacy, education, income and culture. The majority did not assess the impact of locality and those that did were predominately urban. These data suggest that there is a gap in the literature regarding eHealth literacy knowledge for underserved populations, and specifically those in rural locations, within the U.S.

  3. Associations between positive parenting practices and child externalizing behavior in underserved Latino immigrant families.

    Science.gov (United States)

    Holtrop, Kendal; McNeil Smith, Sharde'; Scott, Jenna C

    2015-06-01

    This study examined whether five specific parenting practices (i.e., monitoring, discipline, skill encouragement, problem solving, and positive involvement) were associated with reduced child externalizing behaviors among a sample of Latino immigrant families. It utilized baseline data from 83 Latino couples with children participating in a larger randomized controlled trial of a culturally adapted parenting intervention. Results reveal that monitoring, discipline, skill encouragement, and problem solving each made independent contributions to the prediction of child externalizing behavior, although not all in the expected direction. Further analyses examining mothers and fathers separately suggest that mother-reported monitoring and father-reported discipline practices uniquely contributed to these findings. These results may have important implications for prevention and clinical intervention efforts with Latino immigrant families, including the cultural adaptation and implementation of parenting interventions with this underserved population. © 2014 Family Process Institute.

  4. Against Cursory Treatments in Ethics of Medical Migration from Underserved Countries.

    Science.gov (United States)

    Yuksekdag, Yusuf

    2017-06-01

    In a recent paper, Mpofu, Sen Gupta, and Hays (2016) attempt to outline the obligations of recruiting high-income countries (HICs) and would-be emigrant health workers (HWs) to tackle the effects of mass exodus of health workers from underserved regions. They reconstruct (i) Rawlsian and Kantian global justice approaches to argue for moral obligations of HICs and (ii) an individual justice approach to point to non-enforceable social responsibilities of HWs to assist their compatriots. This critical commentary demonstrates that the argumentation within their individual justice approach is problematic on the basis of three reasons: (1) their discussion under-theorizes and undervalues individual rights and more specifically the right to exit, (2) their argumentation in the latter part, even if problematically, does rather point to moral obligations in lieu of social responsibilities of HWs, and (3) they overlook many other important freedoms, interests, and values pertinent to the issue of retention.

  5. Evaluation of a student-run smoking cessation clinic for a medically underserved population

    Directory of Open Access Journals (Sweden)

    Ebbert Jon O

    2011-03-01

    Full Text Available Abstract Background Smoking is common among medically underserved populations. Accessible resources to encourage and support smoking cessation among these patients are limited. Volunteer medical student-run free smoking cessation clinics may provide an effective option to help these individuals achieve smoking abstinence. In order to demonstrate the feasibility and cost-effectiveness of a student-run clinic, we analyzed a case series of patients receiving care in a medical student-run Smoking Cessation Clinic (SCC at the Rochester, Minnesota Salvation Army Good Samaritan Health Clinic (GSHC. Findings Between January 2005 and March 2009, 282 cigarette smokers seeking care at the SCC were analyzed. Student providers at the SCC conducted 1652 weekly individual counseling sessions averaging 18 minutes per encounter. Patients were offered a choice of pharmacotherapies including nicotine replacement therapy (NRT, bupropion, and varenicline for up to 12 weeks. Smoking abstinence was confirmed with exhaled carbon monoxide (CO. Thirty-two patients completed the entire 12-week program (11.3%. At last contact, 94 patients (33.3% abstained from smoking for ≥ 7 days and 39 patients (13.8% were continuously abstinent for ≥ 4 weeks. The 7-day point prevalence abstinence rates at last contact were 58.6% for varenicline, 41.2% for bupropion, 33.9% for NRT, and 23.5% for bupropion and NRT. Analyzing missing patients as smoking, the 7-day point prevalence abstinence rates were 7.1%, 8.9%, and 8.2%, at 1 month, 2 months, and 3 months after program enrollment, respectively. No serious adverse drug reactions were recorded. Conclusions Our medical student-run smoking cessation clinic provided an effective and safe experience for medically underserved patients who might not otherwise have access to conventional smoking cessation programs because of high cost, lack of insurance, or other disparities. Similar medical student initiatives focusing on healthy lifestyles

  6. Collaboration with pharmacy services in a family practice for the medically underserved

    Directory of Open Access Journals (Sweden)

    Campbell K

    2009-12-01

    Full Text Available Objectives: Pharmacist-managed collaborative services in a family practice setting are described, and diabetes and hypertension outcomes are assessed.Methods: Pharmacist-managed clinics, pharmacotherapy consultations, and drug information services are provided for a medically underserved, predominantly African American population. A pharmacy residency director, an ambulatory care pharmacy resident and three PharmD candidate student pharmacists work directly with physicians, nurse practitioners, nurses, and social workers to form an interdisciplinary health care team. Providers utilize pharmacy services through consultations and referrals. Collaboration outcomes were evaluated in twenty-two patients with diabetes and thirty hypertensive patients. Patients were retrospectively followed throughout their history with pharmacy service. Hemoglobin A1c (A1C was tracked before referral to pharmacy services, 3 to 6 months after, and as the most current measure after at least 6 months. Blood pressure (BP was observed before pharmacy involvement, 2 to 4 months later, and then currently for at least 4 months with the service. The mean of the most current markers was calculated, and the percent of patients at their goal marker was compared to national averages.Results: Fifty percent of pharmacy service patients met the American Diabetes Association hemoglobin A1c goal of less than 7% in our evaluation compared to the national mean of 49.8% overall and 44% in African Americans. Thirty percent of patients were at their BP goal while 33.1% of patients without diabetes and 33.2% of patients with diabetes nationally are at goal. Conclusion: The medically underserved patients under the care of pharmacy services achieved a higher percentage at their A1C goal than the national mean. The percentage of patients who achieved their BP goals was comparable to the national average. Increasing utilization of pharmacy services in the family practice setting allows for

  7. A 5A's communication intervention to promote physical activity in underserved populations

    Directory of Open Access Journals (Sweden)

    Carroll Jennifer K

    2012-10-01

    Full Text Available Abstract Background The present study protocol describes the trial design of a clinician training intervention to improve physical activity counseling in underserved primary care settings using the 5As. The 5As (Ask, Advise, Agree, Assist, Arrange are a clinical tool recommended for health behavior counseling in primary care. Methods/Design The study is a two-arm randomized pilot pragmatic trial to examine a primary care clinician communication intervention on use of the 5As in discussion of physical activity in audio-recorded office visits in an ethnically diverse, low-income patient population. The study setting consists of two federally qualified community health centers in Rochester, NY. Eligible clinicians (n=15 are recruited and randomized into two groups. Group 1 clinicians participate in the training intervention first; Group 2 clinicians receive the intervention six months later. The intervention and its outcomes are informed by self-determination theory and principles of patient-centered communication. Assessment of outcomes is blinded. The primary outcome will be the frequency and quality of 5As discussions as judged by evaluating 375 audio-recorded patient visits distributed over baseline and in the post-intervention period (immediately post and at six months. Secondary outcomes will be changes in patients’ perceived competence to increase physical activity (Aim 2 and patients and clinicians beliefs regarding whether pertinent barriers to promoting exercise have been reduced. (Aim 3. Exploratory outcomes (Aim 4 are potential mediators of the intervention’s effect and whether the intervention affects actual enrollment in the community program recommended for exercise. The analysis will use repeated measures (in the form of recorded office visits from each clinician at each time point and aggregate measures of Groups 1 and 2 over time. Discussion Results will help elucidate the role of 5As communication training for clinicians on

  8. Pop Up/Drill Down: A Traveling Exhibit Designed to Reach Underserved Communities through Art and Geosciences

    Science.gov (United States)

    Kurtz, N.

    2017-12-01

    Scientists observe the world around them in an attempt to understand it. Artists observe the world around them in an attempt to create a reflection or response to the environment. It is critical for the two fields to work together in order to engage and inform the general population. The Consortium for Ocean Leadership, the International Ocean Discovery Program and a series of collaborators are designing a traveling exhibit that will inspire underserved communities in the excitement of exploration, the process of science, and the people and tools required to get there. The project aims to learn more about how to increase access to and awareness of ocean/earth science by bringing a pop-up style museum exhibit to local libraries and public events. As an artist with a science and education background and the graphic designer for this exhibit, this author will highlight the ways this project utilizes art and design to educate underserved populations in ocean and geosciences.

  9. Bolivia programme evaluation of a package to reach an underserved population: Community-based maternal and newborn care economic analysis.

    Science.gov (United States)

    Barger, Diana; Pooley, Bertha; Dupuy, Julien Roger; Cardenas, Norma Amparo; Wall, Steve; Owen, Helen; Daviaud, Emmanuelle

    2017-10-01

    To address inequitable access to health services of indigenous communities in the Bolivian highlands, the Bolivian Ministry of Health, with the support of Save the Children-Saving Newborn Lives, conducted operational research to identify, implement and test a package of maternal and newborn interventions using locally recruited, volunteer Community Health Workers (vCHW) between 2008 and 2010. The additional annual economic and financial costs of the intervention were estimated from the perspective of the Bolivian Ministry of Health in two municipalities. The cost of intervention-stimulated increases in facility attendance was estimated with national surveillance data using a pre-post comparison, adjusted for secular trends in facility attendance. Three scale-up scenarios were modelled by varying the levels of coverage and the number (per mother and child pair) and frequency of home visits. Average cost per mother and average cost per home visit are presented in constant 2015 US$. Eighteen per cent of expectant mothers in the catchment area were visited at least once. The annualized additional financial cost of the community-based intervention across both municipalities was $43 449 of which 3% ($1324) was intervention design, 20% ($8474) set-up and 77% ($33 651) implementation. Drivers of additional costs were additional paid staff (68%), 81% of which was for management and support by local implementing partner and 19% of which was for vCHW supervision. The annual financial cost per vCHW was $595. Modelled scale-up scenarios highlight potential efficiency gains. Recognizing local imperatives to reduce inequalities by targeting underserved populations, the observed low coverage by vCHWs resulted in a high cost per mother and child pair ($296). This evaluation raises important questions about this model's ability to achieve its ultimate goals of reducing neonatal mortality and inequalities through behaviour change and increased care seeking and has served to

  10. Relationship of body mass index and psychosocial factors on physical activity in underserved adolescent boys and girls.

    Science.gov (United States)

    Kitzman-Ulrich, Heather; Wilson, Dawn K; Van Horn, M Lee; Lawman, Hannah G

    2010-09-01

    Previous research indicates that body mass index (BMI) and sex are important factors in understanding physical activity (PA) levels. The present study examined the influence of BMI on psychosocial variables (self-efficacy, social support) and PA in underserved (ethnic minority, low income) boys in comparison with girls. Participants (N = 669; 56% girls; 74% African American) were recruited from the "Active by Choice Today" trial. BMI ʐ score was calculated from objectively collected height and weight data, and PA was assessed with 7-day accelerometry estimates. Self-report questionnaires were used to measure self-efficacy and social support (family, peers) for PA. A 3-way interaction between BMI z score, sex, and family support on PA was shown such that family support was positively associated with PA in normal-weight but not overweight or obese boys, and was not associated with PA in girls. Self-efficacy had the largest effect size related to PA in comparison with the other psychosocial variables studied. Self-efficacy was found to be an important variable related to PA in underserved youth. Future studies should evaluate possible barriers to PA in girls, and overweight youth, to provide more effective family support strategies for underserved adolescents' PA. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  11. Social marketing for a farmer’s market in an underserved community: A needs assessment

    Directory of Open Access Journals (Sweden)

    Meg Skizim

    2018-01-01

    Full Text Available The aim of the present paper is to assess local residents’ awareness of utilizing Supplemental Nutrition Assistance Program (SNAP benefits to purchase fresh produce at local farmers’ markets, and to determine internet use and media preferences of study participants prior to implementation of a social marketing campaign. A needs assessment was conducted to collect baseline data in an underserved neighbourhood in New Orleans (LA, USA. The study was carried out August 2014-May 2015. The assessment revealed that 73% of the respondents were unaware that the SNAP benefits could be used to purchase food in farmers’ markets; 63% of low-income participants never attended a farmers’ market compared to 27% of mid/high-income. Over 50% of the low-income respondents have access to the internet at least once per day. The results show the potential of raising awareness among a wide range of members in the community. This needs assessment will serve as the foundation for a social marketing intervention, which will be disseminated city-wide.

  12. Dental Therapists as New Oral Health Practitioners: Increasing Access for Underserved Populations.

    Science.gov (United States)

    Brickle, Colleen M; Self, Karl D

    2017-09-01

    The development of dental therapy in the U.S. grew from a desire to find a workforce solution for increasing access to oral health care. Worldwide, the research that supports the value of dental therapy is considerable. Introduction of educational programs in the U.S. drew on the experiences of programs in New Zealand, Australia, Canada, and the United Kingdom, with Alaska tribal communities introducing dental health aide therapists in 2003 and Minnesota authorizing dental therapy in 2009. Currently, two additional states have authorized dental therapy, and two additional tribal communities are pursuing the use of dental therapists. In all cases, the care provided by dental therapists is focused on communities and populations who experience oral health care disparities and have historically had difficulties in accessing care. This article examines the development and implementation of the dental therapy profession in the U.S. An in-depth look at dental therapy programs in Minnesota and the practice of dental therapy in Minnesota provides insight into the early implementation of this emerging profession. Initial results indicate that the addition of dental therapists to the oral health care team is increasing access to quality oral health care for underserved populations. As evidence of dental therapy's success continues to grow, mid-level dental workforce legislation is likely to be introduced by oral health advocates in other states. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

  13. ITEAMS: Increasing the Self-Identification for Girls and Underserved Youth in Pursuing STEM Careers

    Directory of Open Access Journals (Sweden)

    R. Bruce Ward

    2012-02-01

    Full Text Available We report early findings on the efficacy of a technology-based project in increasing self-identification for girls and underserved youth to self-select STEM (science, technology, engineering, and mathematics careers. ITEAMS (Innovative Technology- Enabled Astronomy for Middle Schools – an out-of-schooltime program with online, robotic telescopes as its central focus – targets girls and minority students underrepresented in STEMrelated vocations. The participating students attend urban schools in Eastern Massachusetts. ITEAMS’ twofold goal is to: a provide inspiration for the participants to pursue STEM careers, and b increase the students’ mastery of foundational subject matter so they are prepared for the rigor of further STEM study. We use an online system for surveys and assessments, the former to capture attitudinal changes about career choices, and the latter to assess the students’ subject matter knowledge. Participating students take pre-, intermediate, and post subject-matter tests and career-interest surveys. While we find statistically significant gains in subject matter knowledge free of gender, race, or school bias, we also find girls profess less interest than boys in STEM careers as early as grades five and six, although other attitudinal indicators suggest ways to reverse that trend.

  14. Cardiovascular risk in minority and underserved women in Appalachian Tennessee: a descriptive study.

    Science.gov (United States)

    Pearson, Tamera Lea

    2010-04-01

    The purposes of this study were to translate current knowledge regarding cardiovascular risk factors, screening, and prevention to a disparate population of women and to ascertain the cardiovascular health status and risk factors in a sample of minority and underserved Appalachian women. Demographic data were collected from a voluntary sample of women from a disparate population living in Appalachian Tennessee. A coronary risk profile recorded family health history, personal health history, and lifestyle habits affecting risk for cardiovascular disease. Physiologic measurements included body mass index, blood pressure, fasting glucose, cholesterol levels, ankle brachial index, and carotid artery stenosis. Women in Appalachia Tennessee from a disparate population have high risks for heart disease and stroke. This is a critical time to address any modifiable risk factors and aggressively treat underlying cardiovascular diseases such as hypertension and hypercholesterolemia. Nurse practitioners (NPs) often provide primary care to women who may not be aware of their cardiovascular risks or actual disease. NPs can ensure that their practice incorporates primary and secondary cardiovascular prevention through screening, individual health education, and aggressive evidence-based treatment plans for women.

  15. Underserved Pregnant and Postpartum Women's Access and Use of Their Health Records.

    Science.gov (United States)

    Guo, Yuqing; Hildebrand, Janet; Rousseau, Julie; Brown, Brandon; Pimentel, Pamela; Olshansky, Ellen

    The purpose of this study was to examine knowledge of and experiences with use of their electronic health record (EHR) among mostly Hispanic women during pregnancy and postpartum. Women who were in the MOMS Orange County prenatal or postpartum home visitation program completed surveys and participated in focus groups. Descriptive and content analyses were used. Twenty-six women participated. Nearly all women (24, 92.3%) knew what health records were and most (80.8%) felt that keeping their records would increase or greatly increase their confidence in caring for themselves and their families. Approximately one third reported already keeping a copy of their health records. Common barriers to accessing and understanding health records included healthcare providers' noncompliance with the Health Information Technology for Economic and Clinical Health Act, limited EHR adoption, unfriendly patient portals, complicated medical terminology, rushed appointments with healthcare providers, lack of Spanish interpreters, and lack of Spanish-speaking healthcare providers. Programs are needed to educate and support women and providers in using health records to promote health literacy, pregnancy management, and patient-provider relationships in underserved populations.

  16. Identifying elements of patient-centered care in underserved populations: a qualitative study of patient perspectives.

    Directory of Open Access Journals (Sweden)

    Sheela Raja

    Full Text Available Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes.

  17. Dermatologic care in the homeless and underserved populations: observations from the Venice Family Clinic.

    Science.gov (United States)

    Grossberg, Anna L; Carranza, Dafnis; Lamp, Karen; Chiu, Melvin W; Lee, Catherine; Craft, Noah

    2012-01-01

    Dermatologic care in the homeless and impoverished urban underserved populations is rarely described despite the wide prevalence of skin concerns in this population. Because the homeless population may be subject to increased sun exposure compared to the nonhomeless population, they also may be at increased risk for skin cancer. We sought to describe the spectrum of dermatologic diseases seen in a free clinic in Venice, California--the Venice Family Clinic (VFC)--as well as the differences in diagnoses between the homeless and nonhomeless patients seen at this clinic. A retrospective chart review was performed of dermatology patients (N = 82) seen at VFC throughout the 2006 calendar year. The homeless population (n = 22) was found to have more diagnoses of malignant/premalignant growths (25% [16/64] of all homeless diagnoses) compared to their nonhomeless (n = 60) counterparts (6.1% [8/132] of all nonhomeless diagnoses; P < .0001). This difference was sustained when ethnicity was controlled, with 29.6% [16/54] of diagnoses in the homeless white group consisting of malignant/ premalignant growths compared to 8.9% [4/45] of diagnoses in the nonhomeless white cohort (P < .005). Homeless patients may have a higher incidence of skin cancers and precancerous skin lesions due to increased sun exposure and/or limited access to dermatologic care.

  18. Enrolling Underserved Women in mHealth Programs: Results From Text4baby Outreach Campaigns.

    Science.gov (United States)

    Bushar, Jessica A; Fishman, Jodie; Garfinkel, Danielle; Pirretti, Amy

    2018-03-01

    Public health practitioners have increasingly leveraged technology-based communication to get health information into the hands of hard-to-reach populations; however, best practices for outreach and enrollment into mobile health (mHealth) programs are lacking. This article describes enrollment results from campaigns focused on enrolling underserved pregnant women and mothers in Text4baby-a free, mHealth service-to inform outreach strategies for mHealth programs. Text4baby participants receive health and safety information, interactive surveys, alerts, and appointment reminders through at least three weekly texts and a free app-timed to users' due date or babies' birth date. Text4baby worked with partners to implement national, state, and community-based enrollment campaigns. Descriptive statistics were used to compare baseline enrollment prior to a campaign with enrollment during a campaign to generate enrollment estimates. Enrollment rates were calculated for campaigns for which the number targeted/reached was available. National television campaigns resulted in more than 10,000 estimated enrollments. Campaigns that were integrated with an existing program and text-based recruitment had the highest enrollment rates, ranging from 7% to 24%. Facebook advertisements and traditional media targeting providers and consumers were least effective. mHealth programs should consider text-based recruitment and outreach via existing programs; additional research is needed on return on investment for different outreach strategies and on the effectiveness of different outreach strategies at reaching and enrolling specific target populations.

  19. A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan.

    Science.gov (United States)

    Azmat, Syed Khurram; Ali, Moazzam; Hameed, Waqas; Mustafa, Ghulam; Abbas, Ghazanfer; Ishaque, Muhammad; Bilgrami, Mohsina; Temmerman, Marleen

    2014-05-30

    High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women's health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as 'Suraj' (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group.

  20. A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan

    Science.gov (United States)

    2014-01-01

    Background High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women’s health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. Methods/Design This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as ‘Suraj’ (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. Discussion The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group. PMID:24885657

  1. Using information technology to reduce asthma disparities in underserved populations: a pilot study.

    Science.gov (United States)

    Vargas, Perla A; Robles, Elias; Harris, Judith; Radford, Peggy

    2010-10-01

    Low health literacy has been identified as an independent predictor of poor asthma control. The Institute of Medicine considers the role of information technology (IT) as critical in providing "safe, effective, patient centered, timely, efficient, and equitable" care with the potential to reduce health disparities in underserved populations. The aim of this study was to design and evaluate an interactive computer-based questionnaire to assess asthma symptoms in children of parents with limited health literacy and/or limited English proficiency. Volunteer caregivers attending a mobile asthma clinic were randomly assigned to complete the electronic or the paper-and-pencil version of an asthma screening questionnaire (ASQ) in their language of choice (English or Spanish). In the electronic version, a tablet computer was used to present the ASQ questions as video clips and to collect information through the touchscreen. Participants also completed a demographic questionnaire, a brief health literacy questionnaire, and a system usability and satisfaction questionnaire. Reliability of the paper and electronic self-assessments was evaluated by comparing each participant's answers to information they provided during a nurse-guided structured interview (gold standard). A total of 48 parents participated in the study, 26 completed the electronic ASQ and 21 the paper-and-pencil form. Thirty-five percent of the children had well-controlled asthma (n = 17). Most participants were Spanish speaking (67%) Hispanic (n = 44) mothers (n = 43) with a median age of 32 years. More than half had ≤8 years of education (n = 25) and earned education was significant (ρ = .47, p higher than concordance between the paper ASQ and the nurse interview (68% versus 54%; p technology tools may help reduce barriers to access due to inadequate levels of English proficiency and health literacy.

  2. Text4baby program: an opportunity to reach underserved pregnant and postpartum women?

    Science.gov (United States)

    Gazmararian, Julie A; Elon, Lisa; Yang, Baiyu; Graham, Megan; Parker, Ruth

    2014-01-01

    Text4baby was launched in 2010 to promote healthy pregnancies and babies by the use of text messaging. The primary objective of this study was to assess factors related to the enrollment process and reception of text4baby. A prospective cohort study was conducted in two Women, Infant and Children clinics in Atlanta (April 2010-July 2011). Randomly selected pregnant and postpartum women (n = 468) were queried on cell phone use and instructed on text4baby enrollment. Self-enrollment issues were assessed at one-week follow-up (n = 351, 75.0 %), and message reception and reading patterns at two-month follow-up (n = 209, 44.7 %). Forty-two percent of the women had some college education and 82 % had household income education (80 % with some college vs. 62 % with less education), with household income above $10,000 (61 %  $20,000), and among women living in smaller households (77 % 1-3 members vs. 58 % > 3 members) (all p 90 % reported uninterrupted reception and regular reading of messages, and 88 % planned to continue using text4baby. Results also suggested that respondents who were younger (educated and had lower health literacy skills were more likely to have interrupted messages. Despite substantial interest in the text4baby program in an underserved population, innovative ways to help women with significant disadvantages enroll and receive uninterrupted messages are needed.

  3. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol.

    Science.gov (United States)

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-05-18

    The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-built online platform. Two investigators will independently extract methodological variables and outcomes related to patient-level morbidity and mortality and community-level effects on resilience or emergency care capacity. Two investigators will independently assess external validity, selection bias, performance bias, measurement bias, attrition bias and confounding. We will summarise the findings using a narrative approach to highlight similarities and differences between the gathered studies. Formal ethical approval is not required. The results will be disseminated through a peer-reviewed publication and knowledge translation strategy. CRD42014009685. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. The Role of Parenting Practices in the Home Environment among Underserved Youth.

    Science.gov (United States)

    Conlon, Beth A; McGinn, Aileen P; Lounsbury, David W; Diamantis, Pamela M; Groisman-Perelstein, Adriana E; Wylie-Rosett, Judith; Isasi, Carmen R

    2015-08-01

    The home environment, which includes parenting practices, is an important setting in which children develop their health behaviors. We examined the role of parenting practices in the home environment among underserved youth. We examined baseline data of a family-focused pediatric obesity intervention. Parenting practices (monitoring, discipline, limit setting of soda/snacks [SS] and screen media [SM], pressure to eat, and reinforcement) and availability of fruits/vegetables (FV) and sugar-sweetened beverages (SSBs), family meals, television (TV) watching during meals, TVs in the home, owning active video games/sports equipment, and household food security were assessed in 301 parent/caregivers of overweight/obese children (ages 7-12 years; BMI≥85th percentile). Associations were evaluated using Spearman's rank correlation coefficients and logistic regression models adjusted for potential confounders. Parents/caregivers (ages 22-67 years) were largely Hispanic/Latino (74.1%), female (92.4%), and reported high levels of limit setting SS and low levels of pressure to eat. Parent age, gender, country of birth, and years living in the United States accounted for differences among several parenting practices. Adjusted logistic regression models identified several statistically significant associations, including: Monitoring was positively associated with availability FV (odds ratio [OR]=2.19; 95% confidence interval [CI], 1.25, 3.82); limit setting SS was inversely associated with availability of SSBs (OR=0.40; 95% CI, 0.21, 0.75); and limit setting SM was inversely associated with TV viewing during family meals (OR=0.51; 95% CI, 0.31, 0.85). Nearly 40% of our population was food insecure, and food insecurity was positively associated with pressure to eat (OR=1.77; 95% CI, 1.01, 3.15). Parenting practices play an important role in the home environment, and longitudinal studies are needed to examine these associations in the context of family-focused pediatric obesity

  5. Palliative Oncologic Care Curricula for Providers in Resource-Limited and Underserved Communities: a Systematic Review.

    Science.gov (United States)

    Xu, Melody J; Su, David; Deboer, Rebecca; Garcia, Michael; Tahir, Peggy; Anderson, Wendy; Kinderman, Anne; Braunstein, Steve; Sherertz, Tracy

    2017-12-20

    Familiarity with principles of palliative care, supportive care, and palliative oncological treatment is essential for providers caring for cancer patients, though this may be challenging in global communities where resources are limited. Herein, we describe the scope of literature on palliative oncological care curricula for providers in resource-limited settings. A systematic literature review was conducted using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Med Ed Portal databases, and gray literature. All available prospective cohort studies, case reports, and narratives published up to July 2017 were eligible for review. Fourteen articles were identified and referenced palliative care education programs in Argentina, Uganda, Kenya, Australia, Germany, the USA, or multiple countries. The most common teaching strategy was lecture-based, followed by mentorship and experiential learning involving role play and simulation. Education topics included core principles of palliative care, pain and symptom management, and communication skills. Two programs included additional topics specific to the underserved or American Indian/Alaskan Native community. Only one program discussed supportive cancer care, and no program reported educational content on resource-stratified decision-making for palliative oncological treatment. Five programs reported positive participant satisfaction, and three programs described objective metrics of increased educational or research activity. There is scant literature on effective curricula for providers treating cancer patients in resource-limited settings. Emphasizing supportive cancer care and palliative oncologic treatments may help address gaps in education; increased outcome reporting may help define the impact of palliative care curriculum within resource-limited communities.

  6. Registered Nurses' personal rights vs. professional responsibility in caring for members of underserved and disenfranchised populations.

    Science.gov (United States)

    Maze, Claire D Martino

    2005-05-01

    Health disparities exist and refer to the chasms in health status between the advantaged and disadvantaged. Intense multiculturalism will require different approaches and moral obligations to work with these groups and urgency exists to develop nursing caring strategies when dealing with these populations. Development of nursing curricula which identify prejudicial thinking and intolerance for marginalized groups will help to decrease fears and increase nurses' willingness to provide culturally competent health care for underserved and disenfranchised populations. Caring for members of disenfranchised groups instills fear at some level in nurses who are working with these individuals. This fear may be due, in part, to the potential harm nurses perceive the patient may cause them, or perhaps it is because they feel they could possibly be in the individual's situation at some point in their lives. Prejudice and discrimination continue to exist in society and have adversely affected the health care system and the nursing profession. Discrimination may be based on differences due to age, ability, gender, race, ethnicity, religion, sexual orientation, or any characteristics by which people differ. Registered Nurses are accountable for nursing decisions and actions regardless of personal preferences. Due to the rapidly changing healthcare system the nurse faces increasing ethical dilemmas and human rights issues. Nurses are individually accountable for caring for each patient and the right to refuse an assignment should be carefully interpreted to avoid patient abandonment. Nurses' objections can be based on moral, ethical, or religious beliefs not on personal preferences and in an emergency the nurse must provide treatment regardless of any personal objections.

  7. Predictors of Willingness to Use a Smartphone for Research in Underserved Persons Living with HIV

    Science.gov (United States)

    Schnall, Rebecca; Cho, Hwayoung; Webel, Allison

    2017-01-01

    Objectives The burden of HIV/AIDS is borne disproportionally by a growing number of racial and ethnic minorities and socioeconomically disadvantaged individuals. Developing mHealth interventions for the everyday self-management needs of persons living with HIV (PLWH) can be challenging given the current constraints of the U.S. healthcare system, especially for those from underserved communities. In order to develop effective, evidence-based mHealth self-management interventions, we need a better understanding of the factors associated with mHealth research. The purpose of this study was to assess factors associated with PLWH's participation in research using smartphones. Methods We conducted a prospective cohort study (parent study) to examine the relationships among HIV self-management, age, gender and mental wellness. Relevant to this study, we analyzed the relationship between self-reported use of smartphones, willingness to use a smartphone for research, and other predictor variables including: HIV stigma, social isolation, social integration functions, and depression. We selected these variables because previous work indicated they may influence smartphone or mHealth use and because they also tend to be elevated in PLWH. Results We found increased age, HIV stigma and social isolation were negatively associated with smartphone use, which supports the use of smartphones for conducting research with PLWH but also suggest that age, stigma, social integration functions and social isolation need to be considered in research involving PLWH. Conclusions Findings here support smartphone use in research involving PLWH. However, future mHealth interventions targeting PLWH should take into account the inverse relationship between smart phone use and age, HIV stigma, and social isolation, and other predictor variables PMID:28118922

  8. Application of handheld devices to field research among underserved construction worker populations: a workplace health assessment pilot study

    Directory of Open Access Journals (Sweden)

    Fleming Lora E

    2011-04-01

    Full Text Available Abstract Background Novel low-cost approaches for conducting rapid health assessments and health promotion interventions among underserved worker groups are needed. Recruitment and participation of construction workers is particularly challenging due to their often transient periods of work at any one construction site, and their limited time during work to participate in such studies. In the present methodology report, we discuss the experience, advantages and disadvantages of using touch screen handheld devices for the collection of field data from a largely underserved worker population. Methods In March 2010, a workplace-centered pilot study to examine the feasibility of using a handheld personal device for the rapid health assessment of construction workers in two South Florida Construction sites was undertaken. A 45-item survey instrument, including health-related questions on tobacco exposure, workplace safety practices, musculoskeletal disorders and health symptoms, was programmed onto Apple iPod Touch® devices. Language sensitive (English and Spanish recruitment scripts, verbal consent forms, and survey questions were all preloaded onto the handheld devices. The experience (time to survey administration and capital cost of the handheld administration method was recorded and compared to approaches available in the extant literature. Results Construction workers were very receptive to the recruitment, interview and assessment processes conducted through the handheld devices. Some workers even welcomed the opportunity to complete the questionnaire themselves using the touch screen handheld device. A list of advantages and disadvantages emerged from this experience that may be useful in the rapid health assessment of underserved populations working in a variety of environmental and occupational health settings. Conclusions Handheld devices, which are relatively inexpensive, minimize survey response error, and allow for easy storage of data

  9. Application of handheld devices to field research among underserved construction worker populations: a workplace health assessment pilot study.

    Science.gov (United States)

    Caban-Martinez, Alberto J; Clarke, Tainya C; Davila, Evelyn P; Fleming, Lora E; Lee, David J

    2011-04-01

    Novel low-cost approaches for conducting rapid health assessments and health promotion interventions among underserved worker groups are needed. Recruitment and participation of construction workers is particularly challenging due to their often transient periods of work at any one construction site, and their limited time during work to participate in such studies. In the present methodology report, we discuss the experience, advantages and disadvantages of using touch screen handheld devices for the collection of field data from a largely underserved worker population. In March 2010, a workplace-centered pilot study to examine the feasibility of using a handheld personal device for the rapid health assessment of construction workers in two South Florida Construction sites was undertaken. A 45-item survey instrument, including health-related questions on tobacco exposure, workplace safety practices, musculoskeletal disorders and health symptoms, was programmed onto Apple iPod Touch® devices. Language sensitive (English and Spanish) recruitment scripts, verbal consent forms, and survey questions were all preloaded onto the handheld devices. The experience (time to survey administration and capital cost) of the handheld administration method was recorded and compared to approaches available in the extant literature. Construction workers were very receptive to the recruitment, interview and assessment processes conducted through the handheld devices. Some workers even welcomed the opportunity to complete the questionnaire themselves using the touch screen handheld device. A list of advantages and disadvantages emerged from this experience that may be useful in the rapid health assessment of underserved populations working in a variety of environmental and occupational health settings. Handheld devices, which are relatively inexpensive, minimize survey response error, and allow for easy storage of data. These technological research modalities are useful in the

  10. Teaching the content in context: Preparing "highly qualified" and "high quality" teachers for instruction in underserved secondary science classrooms

    Science.gov (United States)

    Tolbert, Sara E.

    2011-12-01

    This dissertation research project presents the results of a longitudinal study that investigates the knowledge, beliefs, and practices of 13 preservice secondary science teachers participating in a science teacher credentialing/Masters program designed to integrate issues of equity and diversity throughout coursework and seminars. Results are presented in the form of three papers: The first paper describes changes in preservice teacher knowledge about contextualization in science instruction, where contextualization is defined as facilitating authentic connections between science learning and relevant personal, social, cultural, ecological, and political contexts of students in diverse secondary classrooms; the second paper relates changes in the self-efficacy and content-specific beliefs about science, science teaching, diversity, and diversity in science instruction; and the final paper communicates the experiences and abilities of four "social justice advocates" learning to contextualize science instruction in underserved secondary placement classrooms. Results indicate that secondary student teachers developed more sophisticated understandings of how to contextualize science instruction with a focus on promoting community engagement and social/environmental activism in underserved classrooms and how to integrate science content and diversity instruction through student-centered inquiry activities. Although most of the science teacher candidates developed more positive beliefs about teaching science in underrepresented classrooms, many teacher candidates still attributed their minority students' underperformance and a (perceived) lack of interest in school to family and cultural values. The "social justice advocates" in this study were able to successfully contextualize science instruction to varying degrees in underserved placement classrooms, though the most significant limitations on their practice were the contextual factors of their student teaching

  11. Hearing the Silenced Voices of Underserved Women -The Role of Qualitative Research in Gynecologic and Reproductive Care

    Science.gov (United States)

    Lawson, Angela K.; Marsh, Erica E.

    2017-01-01

    Summary for Indexing In order to provide effective evidence-based health care to women, rigorous research that examines women’s lived experiences in their own voices in needed. However, clinical health research has often excluded the experiences of women and minority patient populations. Further, clinical research has often relied on quantitative research strategies; this provides an interesting but limited understanding of women’s health experiences and hinders the provision of effective patient-centered care. In this review, we define qualitative research and its unique contributions to research, and provide examples of how qualitative research has given insights into the reproductive health perspectives and behaviors of underserved women. PMID:28160888

  12. Engaging the underserved: a process model to mobilize rural community health coalitions as partners in translational research.

    Science.gov (United States)

    Davis, Melinda M; Aromaa, Susan; McGinnis, Paul B; Ramsey, Katrina; Rollins, Nancy; Smith, Jamie; Beamer, Beth Ann; Buckley, David I; Stange, Kurt C; Fagnan, Lyle J

    2014-08-01

    Community engagement (CE) and community-engaged research (CEnR) are increasingly recognized as critical elements in research translation. Process models to develop CEnR partnerships in rural and underserved communities are needed. Academic partners transformed four established Community Health Improvement Partnerships (CHIPs) into Community Health Improvement and Research Partnerships (CHIRPs). The intervention consisted of three elements: an academic-community kickoff/orientation meeting, delivery of eight research training modules to CHIRP members, and local community-based participatory research (CBPR) pilot studies addressing childhood obesity. We conducted a mixed methods analysis of pre-/postsurveys, interviews, session evaluations, observational field notes, and attendance logs to evaluate intervention effectiveness and acceptability. Forty-nine community members participated; most (78.7%) attended five or more research training sessions. Session quality and usefulness was high. Community members reported significant increases in their confidence for participating in all phases of research (e.g., formulating research questions, selecting research methods, writing manuscripts). All CHIRP groups successfully conducted CBPR pilot studies. The CHIRP process builds on existing infrastructure in academic and community settings to foster CEnR. Brief research training and pilot studies around community-identified health needs can enhance individual and organizational capacity to address health disparities in rural and underserved communities. © 2014 Wiley Periodicals, Inc.

  13. Sustainable Supply of Safe Drinking Water for Underserved Households in Kenya: Investigating the Viability of Decentralized Solutions

    Directory of Open Access Journals (Sweden)

    Pauline Chepchirchir Cherunya

    2015-10-01

    Full Text Available Water quality and safe water sources are pivotal aspects of consideration for domestic water. Focusing on underserved households in Kenya, this study compared user perceptions and preferences on water-service provision options, particularly investigating the viability of decentralized models, such as the Safe Water Enterprise (SWE, as sustainable safe drinking water sources. Results showed that among a number of water-service provision options available, the majority of households regularly sourced their domestic water from more than one source (86% Ngoliba/Maguguni, 98% Kangemi Gichagi. A majority of households perceived their water sources to be unsafe to drink (84% Ngoliba/Maguguni, 73% Kangemi Gichagi. For this reason, drinking water was mainly chlorinated (48% Ngoliba/Maguguni, 33% Kangemi Gichagi or boiled (42% Ngoliba/Maguguni, 67% Kangemi Gichagi. However, this study also found that households in Kenya did not apply these household water treatment methods consistently, thus indicating inconsistency in safe water consumption. The SWE concept, a community-scale decentralized safe drinking water source, was a preferred option among households who perceived it to save time and to be less cumbersome as compared to boiling and chlorination. Willingness to pay for SWE water was also a positive indicator for its preference by the underserved households. However, the long-term applicability of such decentralized water provision models needs to be further investigated within the larger water-service provision context.

  14. An Innovative Multiphased Strategy to Recruit Underserved Adults into a Randomized Trial of a Community-Based Diabetes Risk Reduction Program

    Science.gov (United States)

    Santoyo-Olsson, Jasmine; Cabrera, Julissa; Freyre, Rachel; Grossman, Melanie; Alvarez, Natalie; Mathur, Deepika; Guerrero, Maria; Delgadillo, Adriana T.; Kanaya, Alka M.; Stewart, Anita L.

    2011-01-01

    Purpose: To conduct and evaluate a two-phased community-based approach to recruit lower socioeconomic status, minority, or Spanish-speaking adults at risk of developing diabetes to a randomized trial of a lifestyle intervention program delivered by a public health department. Design: Within geographic areas comprising our target population, 4 community organizations provided local space for conducting the study and program. Phase I—outreach in venues surrounding these organizations—included diabetes education, a short diabetes risk appraisal (DRA), and diabetes risk screening based on a fasting fingerstick glucose test. Phase II—trial recruitment—began concurrently for those found to be at risk of developing diabetes in Phase I by explaining the study, lifestyle program, and research process. Those interested and eligible enrolled in the 1-year study. Results: Over 2 years, approximately 5,110 individuals received diabetes education, 1,917 completed a DRA, and 1,164 were screened of which 641 (55%) had an elevated fingerstick result of ≥106 mg/dl. Of the study sampling frame—persons over age 25 at risk of developing diabetes (N = 544)—238 (43%) enrolled in the trial; of those who were study eligible (n = 427), 56% enrolled. In the final sample, mean age was 56 years (SD = 17), 78% were ethnic minorities, 32% were Spanish-speaking, and 15% had a high school education or less. Implications: Providing diabetes health education and screening prior to study recruitment may help overcome barriers to research participation in underserved communities, thus helping address difficulties recruiting minority and older populations into research, particularly research pertaining to chronic disease risk factors. PMID:21565823

  15. The Reality of Sustaining Community-Based Sport and Physical Activity Programs to Enhance the Development of Underserved Youth: Challenges and Potential Strategies

    Science.gov (United States)

    Whitley, Meredith A.; Forneris, Tanya; Barker, Bryce

    2015-01-01

    Many community-based sport and physical activity programs take a positive youth development approach when operating in underserved communities around the world (Forneris, Whitley, & Barker, 2013). However, one of the biggest challenges for these programs is sustainability (Lindsey, 2008). The purpose of this article is to present the 3…

  16. Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: Cross-sectional analysis of data from Bangladesh, India and Nepal

    NARCIS (Netherlands)

    M. Neuman (Melissa); G. Alcock (Glyn); K. Azad (Kishwar); A. Kuddus (Abdul); D. Osrin (David); N. Shah More (Neena); N. Nair (Nirmala); P. Tripathy (Prasanta); C. Sikorski (Catherine); N. Saville (Naomi); A. Sen (Aman); T. Colbourn (Tim); A.J. Houweling (Tanja); N. Seward (Nadine); A. Manandhar; B. Shrestha (Bhim); A. Costello (Anthony); A. Prost (Audrey)

    2014-01-01

    textabstractObjectives: To describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communities in South Asia. Design: Cross-sectional study. Setting: 81 community-based geographical clusters in four locations in Bangladesh, India

  17. Preparing Historically Underserved Students for STEM Careers: The Role of an Inquiry-based High School Science Sequence Beginning with Physics

    Science.gov (United States)

    Bridges, Jon P.

    Improving the STEM readiness of students from historically underserved groups is a moral and economic imperative requiring greater attention and effort than has been shown to date. The current literature suggests a high school science sequence beginning with physics and centered on developing conceptual understanding, using inquiry labs and modeling to allow students to explore new ideas, and addressing and correcting student misconceptions can increase student interest in and preparation for STEM careers. The purpose of this study was to determine if the science college readiness of historically underserved students can be improved by implementing an inquiry-based high school science sequence comprised of coursework in physics, chemistry, and biology for every student. The study used a retrospective cohort observational design to address the primary research question: are there differences between historically underserved students completing a Physics First science sequence and their peers completing a traditional science sequence in 1) science college-readiness test scores, 2) rates of science college-and career-readiness, and 3) interest in STEM? Small positive effects were found for all three outcomes for historically underserved students in the Physics First sequence.

  18. Evaluation of the Program in Medical Education for the Urban Underserved (PRIME-US) at the UC Berkeley-UCSF Joint Medical Program (JMP): The First 4 Years.

    Science.gov (United States)

    Sokal-Gutierrez, Karen; Ivey, Susan L; Garcia, Roxanna M; Azzam, Amin

    2015-01-01

    Medical educators, clinicians, and health policy experts widely acknowledge the need to increase the diversity of our healthcare workforce and build our capacity to care for medically underserved populations and reduce health disparities. The Program in Medical Education for the Urban Underserved (PRIME-US) is part of a family of programs across the University of California (UC) medical schools aiming to recruit and train physicians to care for underserved populations, expand the healthcare workforce to serve diverse populations, and promote health equity. PRIME-US selects medical students from diverse backgrounds who are committed to caring for underserved populations and provides a 5-year curriculum including a summer orientation, a longitudinal seminar series with community engagement and leadership-development activities, preclerkship clinical immersion in an underserved setting, a master's degree, and a capstone rotation in the final year of medical school. This is a mixed-methods evaluation of the first 4 years of the PRIME-US at the UC Berkeley-UC San Francisco Joint Medical Program (JMP). From 2006 to 2010, focus groups were conducted each year with classes of JMP PRIME-US students, for a total of 11 focus groups; major themes were identified using content analysis. In addition, 4 yearly anonymous, online surveys of all JMP students, faculty and staff were conducted and analyzed. Most PRIME-US students came from socioeconomically disadvantaged backgrounds and ethnic backgrounds underrepresented in medicine, and all were committed to caring for underserved populations. The PRIME-US students experienced many program benefits including peer support, professional role models and mentorship, and curricular enrichment activities that developed their knowledge, skills, and sustained commitment to care for underserved populations. Non-PRIME students, faculty, and staff also benefited from participating in PRIME-sponsored seminars and community-based activities

  19. A Practical Risk Stratification Approach for Implementing a Primary Care Chronic Disease Management Program in an Underserved Community.

    Science.gov (United States)

    Xu, Junjun; Williams-Livingston, Arletha; Gaglioti, Anne; McAllister, Calvin; Rust, George

    2018-01-01

    The use of value metrics is often dependent on payer-initiated health care management incentives. There is a need for practices to define and manage their own patient panels regardless of payer to participate effectively in population health management. A key step is to define a panel of primary care patients with high comorbidity profiles. Our sample included all patients seen in an urban academic family medicine clinic over a two-year period. The simplified risk stratification was built using internal electronic health record and billing system data based on ICD-9 codes. There were 347 patients classified as high-risk out of the 5,364 patient panel. Average age was 59 years (SD 15). Hypertension (90%), hyperlipidemia (62%), and depression (55%) were the most common conditions among high-risk patients. Simplified risk stratification provides a feasible option for our team to understand and respond to the nuances of population health in our underserved community.

  20. The ASSURE Summer REU Program: Introducing research to first-generation and underserved undergraduates through space sciences and engineering projects

    Science.gov (United States)

    Barron, Darcy; Peticolas, Laura; Multiverse Team at UC Berkeley's Space Sciences Lab

    2018-01-01

    The Advancing Space Science through Undergraduate Research Experience (ASSURE) summer REU program is an NSF-funded REU site at the Space Sciences Lab at UC Berkeley that first started in summer 2014. The program recruits students from all STEM majors, targeting underserved students including community college students and first-generation college students. The students have little or no research experience and a wide variety of academic backgrounds, but have a shared passion for space sciences and astronomy. We will describe our program's structure and the components we have found successful in preparing and supporting both the students and their research advisors for their summer research projects. This includes an intensive first week of introductory lectures and tutorials at the start of the program, preparing students for working in an academic research environment. The program also employs a multi-tiered mentoring system, with layers of support for the undergraduate student cohort, as well as graduate student and postdoctoral research advisors.

  1. Do spiritual patients want spiritual interventions?: A qualitative exploration of underserved cancer patients' perspectives on religion and spirituality.

    Science.gov (United States)

    Stein, Emma M; Kolidas, Evelyn; Moadel, Alyson

    2015-02-01

    This study examines religion and spirituality among advanced cancer patients from an underserved, ethnically-diverse population by exploring patient conceptualizations of religion and spirituality, the role of religion and spirituality in coping with cancer, and patient interest in spiritual support. Qualitative semi-structured interviews were conducted with patients who had participated in a study of a "mind-body" support group for patients with all cancer types. Analysis based on grounded theory was utilized to identify themes and theoretical constructs. With regard to patient conceptualizations of religion and spirituality, three categories emerged: (1) Spirituality is intertwined with organized religion; (2) Religion is one manifestation of the broader construct of spirituality; (3) Religion and spirituality are completely independent, with spirituality being desirable and religion not. Religion and spirituality played a central role in patients' coping with cancer, providing comfort, hope, and meaning. Patients diverged when it came to spiritual support, with some enthusiastic about interventions incorporating their spiritual values and others stating that they already get this support through religious communities. Spirituality plays a central role in the cancer experience of this underserved ethnically-diverse population. While spirituality seems to be a universal concern in advanced cancer patients, the meaning of spirituality differs across individuals, with some equating it with organized religion and others taking a more individualized approach. It is important that psychosocial interventions are developed to address this concern. Future research is needed to further explore the different ways that patients conceptualize spirituality and to develop spiritually-based treatments that are not "one size fits all."

  2. Inclusion of underserved racial and ethnic groups in cancer intervention research using new media: a systematic literature review.

    Science.gov (United States)

    Thompson, Hayley S; Shelton, Rachel C; Mitchell, Jamie; Eaton, Tara; Valera, Pamela; Katz, Anne

    2013-12-01

    An increasing number of behavioral and psychosocial cancer interventions incorporate new media elements that are digital, networked, and interactive. However, it is unclear to what extent new media is being leveraged to benefit underserved racial and ethnic groups who disproportionately bear the burden of cancer. This inquiry is timely in light of growing evidence that these groups are receptive to new media. A systematic literature review was conducted to assess the inclusion of these groups in research on cancer-related new media interventions and use of new media to reduce racial and ethnic cancer disparities. A systematic search of three databases was conducted for articles published between January 2000 and March 2012 that presented studies of user experience with a behavioral or psychosocial cancer-related intervention with at least one new media component. Thirty-six articles were included in the final review. In about one-quarter of the studies, less than 20% of participants were African American, Latino, Asian American, or American Indian. In less than 10% of the studies, 80% or more of the samples were members of the aforementioned groups. Almost one-third of the studies reviewed were categorized as disparity focused but limited data were available on racial and ethnic differences in responses to new media interventions. Findings suggest that the promise and potential of new media cancer interventions are largely unrealized among the underserved. Additional research is needed to investigate a wide range of issues related to the development and delivery of such interventions in diverse racial and ethnic groups.

  3. Bringing cutting-edge Earth and ocean sciences to under-served and rural audiences through informal science education

    Science.gov (United States)

    Cooper, S. K.; Petronotis, K. E.; Ferraro, C.; Johnson, K. T. M.; Yarincik, K.

    2017-12-01

    The International Ocean Discovery Program (IODP) is an international marine research collaboration that explores Earth's history and dynamics using ocean-going research platforms to recover data recorded in seafloor sediments and rocks and to monitor subseafloor environments. The JOIDES Resolution is the flagship vessel of IODP and is operated by the National Science Foundation. It is an inspirational hook for STEM Earth and ocean topics for children and the general public of all ages, but is not easily accessible due to its international travels and infrequent U.S. port calls. In response, a consortium of partners has created the Pop-Up/Drill Down Science project. The multi-year project, funded by NSF's Advancing Informal Science Learning program, aims to bring the JR and its science to under-served and rural populations throughout the country. Consisting of an inflatable walk-through ship, a multi-media experience, a giant interactive seafloor map and a series of interactive exhibit kiosks, the exhibit, entitled, In Search of Earth's Secrets: A Pop-Up Science Encounter, will travel to 12 communities throughout the next four years. In each community, the project will partner with local institutions like public libraries and small museums as hosts and to train local Girl Scouts to serve as exhibit facilitators. By working with local communities to select events and venues for pop-up events, the project hopes to bring cutting edge Earth and ocean science in creative new ways to underserved populations and inspire diverse audiences to explore further. This presentation will provide details of the project's goals, objectives and development and provide avenues to become involved.

  4. Attending to Communication and Patterns of Interaction: Culturally Sensitive Mental Health Care for Groups of Urban, Ethnically Diverse, Impoverished, and Underserved Women.

    Science.gov (United States)

    Molewyk Doornbos, Mary; Zandee, Gail Landheer; DeGroot, Joleen

    2014-07-01

    The United States is ethnically diverse. This diversity presents challenges to nurses, who, without empirical evidence to design culturally congruent interventions, may contribute to mental health care disparities. Using Leininger's theory of culture care diversity and universality, this study documented communication and interaction patterns of ethnically diverse, urban, impoverished, and underserved women. Using a community-based participatory research framework, 61 Black, Hispanic, and White women participated in focus groups around their experiences with anxiety/depression. Researchers recorded verbal communication, nonverbal behavior, and patterns of interaction. The women's communication and interaction patterns gave evidence of three themes that were evident across all focus groups and five subthemes that emerged along ethnic lines. The results suggest cultural universalities and cultural uniquenesses relative to the communication and interaction patterns of urban, ethnically diverse, impoverished, and underserved women that may assist in the design of culturally sensitive mental health care. © The Author(s) 2014.

  5. The role of motivation in understanding social contextual influences on physical activity in underserved adolescents in the ACT Trial: a cross-sectional study.

    Science.gov (United States)

    Lawman, Hannah G; Wilson, Dawn K; Van Horn, M Lee; Zarrett, Nicole

    2012-12-01

    Previous research has shown that social contextual factors are important in understanding physical activity (PA) behavior, although little is known about how these factors may relate to PA, especially in underserved adolescents (low income, minorities). This study examined how motivation may differentially mediate the relationship of two social contextual variables (i.e., peer and parent social support) and moderate-to-vigorous PA (MVPA). Baseline data (n = 1421 sixth graders, 54% female, 72% African American) from the Active by Choice Today (ACT) trial in underserved adolescents were analyzed. Motivation was examined as a mediator of the relationships between peer social support, parent social support, and MVPA (measured by 7-day accelerometer estimates). Motivation and peer but not parent support were significantly related to MVPA overall. Significant mediation effects were found indicating motivation partially mediated the relation between peer social support and MVPA and to a lesser degree parent support and MVPA. These findings provide support for the importance of social contextual influences, especially peer social support, on underserved adolescents' PA and motivation for PA.

  6. Camp NERF: methods of a theory-based nutrition education recreation and fitness program aimed at preventing unhealthy weight gain in underserved elementary children during summer months.

    Science.gov (United States)

    Hopkins, Laura C; Fristad, Mary; Goodway, Jacqueline D; Eneli, Ihuoma; Holloman, Chris; Kennel, Julie A; Melnyk, Bernadette; Gunther, Carolyn

    2016-10-26

    The number of obese children in the US remains high, which is problematic due to the mental, physical, and academic effects of obesity on child health. Data indicate that school-age children, particularly underserved children, experience unhealthy gains in BMI at a rate nearly twice as fast during the summer months. Few efforts have been directed at implementing evidence-based programming to prevent excess weight gain during the summer recess. Camp NERF is an 8-week, multi-component (nutrition, physical activity, and mental health), theory-based program for underserved school-age children in grades Kindergarten - 5th coupled with the USDA Summer Food Service Program. Twelve eligible elementary school sites will be randomized to one of the three programming groups: 1) Active Control (non-nutrition, physical activity, or mental health); 2) Standard Care (nutrition and physical activity); or 3) Enhanced Care (nutrition, physical activity, and mental health) programming. Anthropometric, behavioral, and psychosocial data will be collected from child-caregiver dyads pre- and post-intervention. Site-specific characteristics and process evaluation measures will also be collected. This is the first, evidence-based intervention to address the issue of weight gain during the summer months among underserved, school-aged children. Results from this study will provide researchers, practitioners, and public health professionals with insight on evidence-based programming to aid in childhood obesity prevention during this particular window of risk. NCT02908230/09-19-2016.

  7. A mixed-methods examination of communication between oncologists and primary care providers among primary care physicians in underserved communities.

    Science.gov (United States)

    Shen, Megan Johnson; Binz-Scharf, Maria; D'Agostino, Tom; Blakeney, Natasha; Weiss, Elisa; Michaels, Margo; Patel, Shilpa; McKee, M Diane; Bylund, Carma L

    2015-03-15

    Research has demonstrated that communication and care coordination improve cancer patient outcomes. To improve communication and care coordination, it is important to understand primary care providers' (PCPs') perceptions of communication with oncologists as well as PCPs' communication needs. A mixed-methods approach was used in the present study. In the qualitative phase of the study, 18 PCPs practicing in underserved, minority communities were interviewed about their experiences communicating with oncologists. In the quantitative phase of the study, 128 PCPs completed an online survey about their preferences, experiences, and satisfaction with communication with oncologists. Results indicated a PCP-oncologist gap in communication occurred between diagnosis and treatment. PCPs wanted more communication with oncologists, updates on their patients' prognosis throughout treatment, and to be contacted via telephone or email and saw their role as crucial in providing supportive care for their patients. Although PCPs recognize that they play a critical, proactive role in supporting patients throughout the continuum of their cancer care experience, existing norms regarding postreferral engagement and oncologist-PCP communication often hinder activation of this role among PCPs. Expected standards regarding the method, frequency, and quality of postreferral communication should be jointly articulated and made accountable between PCPs and oncologists to help improve cancer patients' quality of care, particularly in minority communities. © 2014 American Cancer Society.

  8. The association between women's self-rated health and satisfaction with environmental services in an underserved community in Lebanon.

    Science.gov (United States)

    Habib, Rima R; Elzein, Kareem; Hojeij, Safa

    2013-01-01

    This research evaluated the association between women's self-rated health and a number of socioeconomic and environmental health indicators relating to drinking water services in an underserved Lebanese community. A population-based, cross-sectional survey using interviews was adopted to obtain information from female homemakers of 2,223 households in the town of Bebnine, Lebanon. The questionnaire included indicators on self-rated health, satisfaction with water quality, source of drinking water, occurrence of diarrhea, and socioeconomic variables, such as education, occupation, and perceived economic status. Self-rated health was categorized as poor, fair, and good. Odds ratios for poor and fair compared to good self-rated health values were calculated using multinomial logistic regression. A total of 712 women (32%) reported poor self-rated health. Women who perceived their household income to be worse than others in town were four times as likely to report poor health. Compared to women who were satisfied with drinking water quality, dissatisfied women were 42% more likely to report poor health. Women living in households reporting recent episodes of diarrheal illness had poorer health ratings than those without. The findings suggest a positive relationship between individual perceptions of water quality and self-rated health. Community concerns over their surrounding environment serve as a primary guide for infrastructural development and government policy.

  9. Assessing internet access and use in a medically underserved population: implications for providing enhanced health information services.

    Science.gov (United States)

    Zach, Lisl; Dalrymple, Prudence W; Rogers, Michelle L; Williver-Farr, Heather

    2012-03-01

    The relationship between health information seeking, patient engagement and health literacy is not well understood. This is especially true in medically underserved populations, which are often viewed as having limited access to health information. To improve communication between an urban health centre and the community it serves, a team of library and information science researchers undertook an assessment of patients' level and methods of access to and use of the Internet. Data were collected in 53 face-to-face anonymous interviews with patients at the centre. Interviews were tape-recorded for referential accuracy, and data were analysed to identify patterns of access and use. Seventy-two percentage of study participants reported having access to the Internet through either computers or cell phones. Barriers to Internet access were predominantly lack of equipment or training rather than lack of interest. Only 21% of those with Internet access reported using the Internet to look for health information. The findings suggest that lack of access to the Internet in itself is not the primary barrier to seeking health information in this population and that the digital divide exists not at the level of information access but rather at the level of information use. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

  10. Pediatric Obesity Empowerment Model Group Medical Visits (POEM-GMV) as Treatment for Pediatric Obesity in an Underserved Community.

    Science.gov (United States)

    Geller, Jeffrey S; Dube, Eileen T; Cruz, Glavielinys A; Stevens, Jason; Keating Bench, Kara

    2015-10-01

    This is a retrospective cohort study to evaluate a novel group medical visit (GMV) program using an empowerment curriculum as treatment for pediatric obesity in a federally qualified community health center. Biometric and self-reported data were reviewed from 417 overweight or obese children ages 5-18 attending the pediatric obesity empowerment model GMV program (POEM-GMV) at least twice during a 3-year period. Variables were evaluated using paired means t-test. Pearson's correlation test was used to evaluate variables and the BMI z-score. Subanalysis by gender was performed. The average participant was 10.48 ± 2.53 years old and participated for 301 ± 287 days. BMI z-score reduced from 2.99 ± 0.96 to 2.88 ± 0.88 (p pediatric obesity in an underserved community. There were statistically significantly improved outcomes in obesity, especially for boys. Significant improvement was observed in many lifestyle factors associated with obesity. Weight loss most closely correlated with reduced stress levels and sugary beverage consumption. Additional studies are needed to further evaluate the efficacy of POEM-GMV.

  11. Dental care for the underserved children of Monterey County: meeting the challenge.

    Science.gov (United States)

    Stewart, R E

    1998-05-01

    With its expansive area, and the special needs of agricultural workers, Monterey County held significant challenges for setting up a children's health clinic. Part of the solution to addressing the county's unmet dental needs was the establishment of the Children's Miracle Network dental center in 1995. But working in the fields leaves little time for travel to appointments, so the dental center expanded to a mobile unit that can go where the need is. Understanding the special needs of one's community is crucial to establishing programs that can successfully address the state's needs for children's dental care.

  12. Behavioral Economics: “Nudging” Underserved Populations to Be Screened for Cancer

    Science.gov (United States)

    Thompson, Tess; Kreuter, Matthew W.; McBride, Timothy D.

    2015-01-01

    Persistent disparities in cancer screening by race/ethnicity and socioeconomic status require innovative prevention tools and techniques. Behavioral economics provides tools to potentially reduce disparities by informing strategies and systems to increase prevention of breast, cervical, and colorectal cancers. With an emphasis on the predictable, but sometimes flawed, mental shortcuts (heuristics) people use to make decisions, behavioral economics offers insights that practitioners can use to enhance evidence-based cancer screening interventions that rely on judgments about the probability of developing and detecting cancer, decisions about competing screening options, and the optimal presentation of complex choices (choice architecture). In the area of judgment, we describe ways practitioners can use the availability and representativeness of heuristics and the tendency toward unrealistic optimism to increase perceptions of risk and highlight benefits of screening. We describe how several behavioral economic principles involved in decision-making can influence screening attitudes, including how framing and context effects can be manipulated to highlight personally salient features of cancer screening tests. Finally, we offer suggestions about ways practitioners can apply principles related to choice architecture to health care systems in which cancer screening takes place. These recommendations include the use of incentives to increase screening, introduction of default options, appropriate feedback throughout the decision-making and behavior completion process, and clear presentation of complex choices, particularly in the context of colorectal cancer screening. We conclude by noting gaps in knowledge and propose future research questions to guide this promising area of research and practice. PMID:25590600

  13. Exclusionary policies in urban development: Under-servicing migrant households in Brazilian cities.

    Science.gov (United States)

    Feler, Leo; Henderson, J Vernon

    2011-05-01

    Localities in developed countries often enact regulations to deter low-income households from moving in. In developing countries, such restrictions lead to the emergence of informal housing sectors. To deter low-income migrants, localities in developing countries withhold public services to the informal housing sector. Using a large sample of Brazilian localities, we examine migration and exclusion, focusing on the public provision of water to small houses where low-income migrants are likely to live. Withholding water connections reduces the locality growth rate, particularly of low-education households. In terms of service provision, during dictatorship in Brazil, we find evidence of strategic exclusion, where localities appear to withhold services to deter in-migration. We also find evidence of strategic interactions among localities within metro areas in their setting of service levels: if one locality provides more services to migrant households, other localities respond by withholding service.

  14. Exclusionary policies in urban development: Under-servicing migrant households in Brazilian cities

    Science.gov (United States)

    Feler, Leo; Henderson, J. Vernon

    2012-01-01

    Localities in developed countries often enact regulations to deter low-income households from moving in. In developing countries, such restrictions lead to the emergence of informal housing sectors. To deter low-income migrants, localities in developing countries withhold public services to the informal housing sector. Using a large sample of Brazilian localities, we examine migration and exclusion, focusing on the public provision of water to small houses where low-income migrants are likely to live. Withholding water connections reduces the locality growth rate, particularly of low-education households. In terms of service provision, during dictatorship in Brazil, we find evidence of strategic exclusion, where localities appear to withhold services to deter in-migration. We also find evidence of strategic interactions among localities within metro areas in their setting of service levels: if one locality provides more services to migrant households, other localities respond by withholding service. PMID:22707807

  15. Collaboration Among Institutions to Bring Geospatial Technology to an Underserved Rural Region

    Science.gov (United States)

    Johnson, T.

    2012-12-01

    The University of Maine at Machias and Washington County Community College, the two smallest and most remote public institutions in Maine, provide important education and workforce development services in a rural and economically-challenged region. Through an innovative collaboration supported by the National Science Foundation, the two institutions have developed geospatial technology (GST) programs designed to meet the specific workforce needs of the region, affording students with the opportunity to pursue degrees, certificates and minors. Prior to this effort, neither school had the resources to maintain a GST laboratory or to offer courses consistently. The region had almost no GST capacity with which to manage critical environmental resources and grapple with economic, public safety, and public health challenges. Several statewide studies had shown a growing need for more GST technicians and training for incumbent workers. The new programs are designed to produce a small number of specialist technicians with associate's degrees and a large number of ancillary users with significant GST expertise from courses, certificates or minors. Course content is shaped by workforce research in Maine and elsewhere, and all courses are offered in either blended, online or short-term intensive formats to provide access to incumbent workers and extend the geographic reach of the programs. Through the university's Geographic Information Systems (GIS) Service Center, students from both institutions engage in real-world projects, and are linked with employers via internships. This has the added plus of providing low-cost and no-cost GIS services to area clients, generating demand. Many of these projects and internships lead to work for graduates, even through the economic downturn. By creating courses that serve multiple audiences, each contributing a small number to the total enrollment, the programs constitute a sustainable model that serves the growing needs of the region

  16. The Breast and Cervical Cancer Early Detection Program, Medicaid, and breast cancer outcomes among Ohio's underserved women.

    Science.gov (United States)

    Koroukian, Siran M; Bakaki, Paul M; Htoo, Phyo Than; Han, Xiaozhen; Schluchter, Mark; Owusu, Cynthia; Cooper, Gregory S; Rose, Johnie; Flocke, Susan A

    2017-08-15

    As an organized screening program, the national Breast and Cervical Cancer Early Detection Program (BCCEDP) was launched in the early 1990s to improve breast cancer outcomes among underserved women. To analyze the impact of the BCCEDP on breast cancer outcomes in Ohio, this study compared cancer stages and mortality across BCCEDP participants, Medicaid beneficiaries, and "all others." This study linked data across the Ohio Cancer Incidence Surveillance System, Medicaid, the BCCEDP database, death certificates, and the US Census and identified 26,426 women aged 40 to 64 years who had been diagnosed with incident invasive breast cancer during the years 2002-2008 (deaths through 2010). The study groups were as follows: BCCEDP participants (1-time or repeat users), Medicaid beneficiaries (women enrolled in Medicaid before their cancer diagnosis [Medicaid/prediagnosis] or around the time of their cancer diagnosis [Medicaid/peridiagnosis]), and all others (women identified as neither BCCEDP participants nor Medicaid beneficiaries). The outcomes included advanced-stage cancer at diagnosis and mortality. A multivariable logistic and survival analysis was conducted to examine the independent association between the BCCEDP and Medicaid status and the outcomes. The percentage of women presenting with advanced-stage disease was highest among women in the Medicaid/peridiagnosis group (63.4%) and lowest among BCCEDP repeat users (38.6%). With adjustments for potential confounders and even in comparison with Medicaid/prediagnosis beneficiaries, those in the Medicaid/peridiagnosis group were twice as likely to be diagnosed with advanced-stage disease (adjusted odds ratio, 2.20; 95% confidence interval, 1.83-2.66). Medicaid/peridiagnosis women are at particularly high risk to be diagnosed with advanced-stage disease. Efforts to reduce breast cancer disparities must target this group of women before they present to Medicaid. Cancer 2017;123:3097-106. © 2017 American Cancer Society

  17. Care Provided by Students in Community-Based Dental Education: Helping Meet Oral Health Needs in Underserved Communities.

    Science.gov (United States)

    Mays, Keith A; Maguire, Meghan

    2018-01-01

    Since 2000, reports have documented the challenges faced by many Americans in receiving oral health care and the consequences of inadequate care such as high levels of dental caries among many U.S. children. To help address this problem, many dental schools now include community-based dental education (CBDE) in their curricula, placing students in extramural clinics where they provide care in underserved communities. CBDE is intended to both broaden the education of future oral health professionals and expand care for patients in community clinics. The aim of this study was to develop a three-year profile of the patients seen and the care provided by students at extramural clinics associated with one U.S. dental school. Three student cohorts participated in the rotations: final-year students in the Doctor of Dental Surgery, Bachelor of Science in Dental Hygiene, and Master of Dental Therapy programs. The study was a retrospective analysis of data retrieved from the school's database for three consecutive academic years. The data included patients' demographics and special health care needs status (based on information collected by students from their patients) and procedures students performed while on rotations. For the three-year period, the results showed a total of 43,128 patients were treated by 418 student providers. Approximately 25% of all encounters were with pediatric patients. Students completed 5,908 child prophylaxis, 5,386 topical fluoride varnish, and 7,678 sealant procedures on pediatric patients. Annually, 7% of the total patients treated had special health care needs. The results show that these students in CBDE rotations provided a substantial amount of oral health care at extramural sites and gained additional experience in caring for a diverse population of patients and performing a wide range of procedures.

  18. Validation of English and Spanish-language versions of a screening questionnaire for rheumatoid arthritis in an underserved community.

    Science.gov (United States)

    Potter, Jeffrey; Odutola, Jennifer; Gonzales, Christian Amurrio; Ward, Michael M

    2008-08-01

    Questionnaires to screen for rheumatoid arthritis (RA) have been tested in groups that were primarily well educated and Caucasian. We sought to validate the RA questions of the Connective Tissue Disease Screening Questionnaire (CSQ) in ethnic minorities in an underserved community, and to test a Spanish-language version. The Spanish-language version was developed by 2 native speakers. Consecutive English-speaking or Spanish-speaking patients in a community-based rheumatology practice completed the questionnaire. Diagnoses were confirmed by medical record review. Sensitivity and specificity of the questionnaire for a diagnosis of RA were computed for each language version, using 2 groups as controls: patients with noninflammatory conditions, and participants recruited from the community. The English-language version was tested in 53 patients with RA (79% ethnic minorities; mean education level 11.3 yrs), 85 rheumatology controls with noninflammatory conditions, and 82 community controls. Using 3 positive responses as indicating a positive screening test, the sensitivity of the questionnaire was 0.77, the specificity based on rheumatology controls was 0.45, and the specificity based on community controls was 0.94. The Spanish-language version was tested in 55 patients with RA (mean education level 7.8 yrs), 149 rheumatology controls, and 88 community controls. The sensitivity of the Spanish-language version was 0.87, with specificities of 0.60 and 0.97 using the rheumatology controls and community controls, respectively. The sensitivity of the English-language version of the RA questions of the CSQ was lower in this study than in other cohorts, reflecting differences in the performance of the questions in different ethnic or socioeconomic groups. The Spanish-language version demonstrated good sensitivity, and both had excellent specificity when tested in community controls.

  19. Integrating community-based participatory research and informatics approaches to improve the engagement and health of underserved populations.

    Science.gov (United States)

    Unertl, Kim M; Schaefbauer, Chris L; Campbell, Terrance R; Senteio, Charles; Siek, Katie A; Bakken, Suzanne; Veinot, Tiffany C

    2016-01-01

    We compare 5 health informatics research projects that applied community-based participatory research (CBPR) approaches with the goal of extending existing CBPR principles to address issues specific to health informatics research. We conducted a cross-case analysis of 5 diverse case studies with 1 common element: integration of CBPR approaches into health informatics research. After reviewing publications and other case-related materials, all coauthors engaged in collaborative discussions focused on CBPR. Researchers mapped each case to an existing CBPR framework, examined each case individually for success factors and barriers, and identified common patterns across cases. Benefits of applying CBPR approaches to health informatics research across the cases included the following: developing more relevant research with wider impact, greater engagement with diverse populations, improved internal validity, more rapid translation of research into action, and the development of people. Challenges of applying CBPR to health informatics research included requirements to develop strong, sustainable academic-community partnerships and mismatches related to cultural and temporal factors. Several technology-related challenges, including needs to define ownership of technology outputs and to build technical capacity with community partners, also emerged from our analysis. Finally, we created several principles that extended an existing CBPR framework to specifically address health informatics research requirements. Our cross-case analysis yielded valuable insights regarding CBPR implementation in health informatics research and identified valuable lessons useful for future CBPR-based research. The benefits of applying CBPR approaches can be significant, particularly in engaging populations that are typically underserved by health care and in designing patient-facing technology. © The Authors 2015. Published by Oxford University Press on behalf of the American Medical

  20. Telehealth for diabetes self-management education and support in an underserved, free clinic population: A pilot study.

    Science.gov (United States)

    Threatt, Tiffaney B; Ward, Eileen D

    Primary study objectives were to (1) describe mean change in A1c from baseline of a free clinic population enrolled in telehealth diabetes self-management education and support (DSME/S) services and (2) to compare change in A1C and other clinical outcomes measures with free clinic patients enrolled in a traditional face-to-face DSME/S program. An exploratory study design and comparative evaluation of telehealth DSME/S services in a free clinic population was used. Baseline clinical measures were collected upon referral. Diabetes educators met with patients individually over 2-3 months. Clinical outcomes measures were collected within 6 months of program completion. Data from the telehealth group was assessed individually and compared to a free clinic traditional DSME/S program population. Twelve patients completed a telehealth free clinic DSME/S pilot program with a mean ± SD change in A1C from baseline of -1.03 ± 1.53% (P = 0.050). Mean ± SD change in A1C from baseline in the free clinic population participating in traditional face-to-face DSME/S services was -1.42 ± 1.80% (P = 0.001). No significant differences in secondary outcomes measures, including body mass index and blood pressure, were revealed among the study populations. Expanding access to care in populations faced with challenges of socioeconomics, limited education, and lower health literacy is a step toward reducing health disparities and positively affecting care. Mean A1C can be improved with telehealth DSME/S services in an underserved, free clinic population. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  1. Effects of racial and ethnic group and health literacy on responses to genomic risk information in a medically underserved population.

    Science.gov (United States)

    Kaphingst, Kimberly A; Stafford, Jewel D; McGowan, Lucy D'Agostino; Seo, Joann; Lachance, Christina R; Goodman, Melody S

    2015-02-01

    Few studies have examined how individuals respond to genomic risk information for common, chronic diseases. This randomized study examined differences in responses by type of genomic information (genetic test/family history) and disease condition (diabetes/heart disease), and by race/ethnicity in a medically underserved population. 1,057 English-speaking adults completed a survey containing 1 of 4 vignettes (2-by-2 randomized design). Differences in dependent variables (i.e., interest in receiving genomic assessment, discussing with doctor or family, changing health habits) by experimental condition and race/ethnicity were examined using chi-squared tests and multivariable regression analysis. No significant differences were found in dependent variables by type of genomic information or disease condition. In multivariable models, Hispanics were more interested in receiving a genomic assessment than Whites (OR = 1.93; p literacy had greater interest than those with adequate health literacy. Blacks (OR = 1.78; p = .001) and Hispanics (OR = 1.85; p = .001) had greater interest in discussing information with family than Whites. Non-Hispanic Blacks (OR = 1.45; p = .04) had greater interest in discussing genomic information with a doctor than Whites. Blacks (β = -0.41; p literacy was negatively associated with number of health habits participants intended to change. Findings suggest that race/ethnicity may affect responses to genomic risk information. Additional research could examine how cognitive representations of this information differ across racial/ethnic groups. Health literacy is also critical to consider in developing approaches to communicating genomic information.

  2. Macular edema in underserved diabetic patients: Improving detection by enhancing the optical signature and data analysis techniques

    Science.gov (United States)

    Alhamami, Mastour Abdullah

    Diabetic retinopathy and diabetic macular edema are chief causes of vision loss in working adults. Thus, retinal screening of patients with diabetes has become standard practice in some countries to prevent visual impairment and blindness from diabetic retinopathy. One goal is to improve techniques currently used to diagnose diabetic retinopathy. Another goal is to probe pathophysiological changes seen with imaging methods. Analysis was performed on a novel dataset from more than 2000 underserved adult diabetic patients, who were recruited for a screening study for diabetic eye disease. Data were collected from four county clinics at Alameda Health, Alameda County, CA. Over 90% of patients self-identified as a racial/ethnic identity other than non-Hispanic white. We investigated the prevalence and optical properties of macular edema. In the first study, a retrospective cohort study was performed to compare macular thickness in diabetic patients with and without macular edema to determine the presence of damage to the external limiting membrane or and the relation of damage to the ELM to damage to photoreceptors. In the second study, we investigated whether the information in red light better visualizes cysts in diabetic macular edema, as compared to green light. In the third study, we investigated whether the demographic and blood glucose information predict diabetic macular edema. Three logistic regression analyses were compared. In the fourth study, we examined how different outcome measures of retinal thickness vary with demographic and blood glucose measures, using a trichotomous variable for retinal thickness. The findings point strongly to large individual differences in the development of macular edema, which is difficult to diagnose with the most common methods in dark eyes. Further, while blood glucose was found to be important, there are additional differences in the potential for macular edema that are associated with ethnic group and gender.

  3. Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population.

    Science.gov (United States)

    Thomas, Mary-Powel; Ammann, Gabriela; Brazier, Ellen; Noyes, Philip; Maybank, Aletha

    2017-12-01

    Women of color in the United States, particularly in high-poverty neighborhoods, experience high rates of poor birth outcomes, including cesarean section, preterm birth, low birthweight, and infant mortality. Doula care has been linked to improvements in many perinatal outcomes, but women of color and low-income women often face barriers in accessing doula support. To address this issue, the New York City Department of Health and Mental Hygiene's Healthy Start Brooklyn introduced the By My Side Birth Support Program in 2010. The goal was to complement other maternal home-visiting programs by providing doula support during labor and birth, along with prenatal and postpartum visits. Between 2010 and 2015, 489 infants were born to women enrolled in the program. Data indicate that By My Side is a promising model of support for Healthy Start projects nationwide. Compared to the project area, program participants had lower rates of preterm birth (6.3 vs. 12.4%, p < 0.001) and low birthweight (6.5 vs. 11.1%, p = 0.001); however, rates of cesarean birth did not differ significantly (33.5 vs. 36.9%, p = 0.122). Further research is needed to explore possible reasons for this finding, and to examine the influence of doula support on birth outcomes among populations with high rates of chronic disease and stressors such as poverty, racism, and exposure to violence. However, feedback from participants indicates that doula support is highly valued and helps give women a voice in consequential childbirth decisions. Available evidence suggests that doula services may be an important component of an effort to address birth inequities.

  4. Self-care self-efficacy, religious participation and depression as predictors of poststroke self-care among underserved ethnic minorities

    Directory of Open Access Journals (Sweden)

    Suzanne M. Robertson

    2013-04-01

    Full Text Available Underserved ethnic minorities have multiple chronic disease risk factors, including tobacco, alcohol and substance use, which contribute to increased incidence of stroke. Self-efficacy (self-care self-efficacy, religious participation and depression may directly and indirectly influence engagement in post stroke self-care behaviors. The primary aim of the present study was to investigate the effects of self-care self-efficacy, religious participation and depression, on tobacco, alcohol and substance use in a sample of largely ethnic minority, underserved stroke survivors (n=52. Participants previously recruited for a culturally tailored secondary stroke prevention self-care intervention were included. The treatment group received three stroke self-care sessions. The usual care group completed assessments only. Both groups were included in these analyses. Main outcome measures included tobacco, alcohol and substance use. Self-care self-efficacy, religious participation and depression were also assessed. Logistic regression analyses, using self-efficacy, religious practice and depression as the referents, were used to predict binary outcomes of tobacco, alcohol and substance use at 4-weeks post-stroke. Higher depression and self-care self-efficacy were associated with reduced odds of smoking and substance use. Greater participation in religious activities was associated with lower odds of alcohol use. We can conclude that incorporating depression treatment and techniques to increase self-care self-efficacy, and encouraging religious participation may help to improve stroke self-care behaviors for underserved and low socioeconomic status individuals. Results are discussed in the context of stroke self-management.

  5. A randomized controlled trial to assess the efficacy of an interactive mobile messaging intervention for underserved smokers: Project ACTION.

    Science.gov (United States)

    Vidrine, Damon J; Fletcher, Faith E; Danysh, Heather E; Marani, Salma; Vidrine, Jennifer Irvin; Cantor, Scott B; Prokhorov, Alexander V

    2012-08-25

    Despite a significant decrease in smoking prevalence over the past ten years, cigarette smoking still represents the leading cause of preventable morbidity and mortality in the United States. Moreover, smoking prevalence is significantly higher among those with low levels of education and those living at, or below, the poverty level. These groups tend to be confronted with significant barriers to utilizing more traditional smoking cessation intervention approaches. The purpose of the study, Project ACTION (Adult smoking Cessation Treatment through Innovative Outreach to Neighborhoods), is to utilize a mobile clinic model, a network of community sites (i.e., community centers and churches) and an interactive mobile messaging system to reach and deliver smoking cessation treatment to underserved, low-income communities. We are using a group-randomized design, with the community site as the sampling unit, to compare the efficacy of three smoking cessation interventions: 1) Standard Care--brief advice to quit smoking, nicotine replacement therapy (NRT), and self-help materials; 2) Enhanced Care--standard care components plus a cell phone-delivered text/graphical messaging component; and 3) Intensive Care--enhanced care components plus a series of 11 cell phone-delivered proactive counseling sessions. An economic evaluation will also be performed to evaluate the relative cost effectiveness of the three treatment approaches. We will recruit 756 participants (252 participants in each of the 3 intervention groups). At the time of randomization, participants complete a baseline assessment, consisting of smoking history, socio-demographic, and psychosocial variables. Monthly cell phone assessments are conducted for 6 months-post enrollment, and a final 12-month follow-up is conducted at the original neighborhood site of enrollment. We will perform mixed-model logistic regression to compare the efficacy of the three smoking cessation intervention treatment groups. It is

  6. A randomized controlled trial to assess the efficacy of an interactive mobile messaging intervention for underserved smokers: Project ACTION

    Directory of Open Access Journals (Sweden)

    Vidrine Damon J

    2012-08-01

    Full Text Available Abstract Background Despite a significant decrease in smoking prevalence over the past ten years, cigarette smoking still represents the leading cause of preventable morbidity and mortality in the United States. Moreover, smoking prevalence is significantly higher among those with low levels of education and those living at, or below, the poverty level. These groups tend to be confronted with significant barriers to utilizing more traditional smoking cessation intervention approaches. The purpose of the study, Project ACTION (Adult smoking Cessation Treatment through Innovative Outreach to Neighborhoods, is to utilize a mobile clinic model, a network of community sites (i.e., community centers and churches and an interactive mobile messaging system to reach and deliver smoking cessation treatment to underserved, low-income communities. Methods/Design We are using a group-randomized design, with the community site as the sampling unit, to compare the efficacy of three smoking cessation interventions: 1 Standard Care - brief advice to quit smoking, nicotine replacement therapy (NRT, and self-help materials; 2 Enhanced Care - standard care components plus a cell phone-delivered text/graphical messaging component; and 3 Intensive Care - enhanced care components plus a series of 11 cell phone-delivered proactive counseling sessions. An economic evaluation will also be performed to evaluate the relative cost effectiveness of the three treatment approaches. We will recruit 756 participants (252 participants in each of the 3 intervention groups. At the time of randomization, participants complete a baseline assessment, consisting of smoking history, socio-demographic, and psychosocial variables. Monthly cell phone assessments are conducted for 6 months-post enrollment, and a final 12-month follow-up is conducted at the original neighborhood site of enrollment. We will perform mixed-model logistic regression to compare the efficacy of the three smoking

  7. Extending the Pathway: Building on a National Science Foundation Workforce Development Project for Underserved k-12 Students

    Science.gov (United States)

    Slattery, W.; Smith, T.

    2014-12-01

    own learning and shows promise of raising parents, teachers, administrators and other k-12 students awareness of educational opportunities in the geosciences, confidence in the ability of underserved rural students to reach their educational goals and supporting them through the critical middle and high school years towards a geoscience career.

  8. Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: a mixed methods study.

    Science.gov (United States)

    Alcock, Glyn; Das, Sushmita; Shah More, Neena; Hate, Ketaki; More, Sharda; Pantvaidya, Shanti; Osrin, David; Houweling, Tanja A J

    2015-09-28

    Discussions of maternity care in developing countries tend to emphasise service uptake and overlook choice of provider. Understanding how families choose among health providers is essential to addressing inequitable access to care. Our objectives were to quantify the determinants and choice of maternity care provider in Mumbai's informal urban settlements, and to explore the reasons underlying their choices. The study was conducted in informal urban communities in eastern Mumbai. We developed regression models using data from a census of married women aged 15-49 to test for associations between maternal characteristics and uptake of care and choice of provider. We then conducted seven focus group discussions and 16 in-depth interviews with purposively selected participants, and used grounded theory methods to examine the reasons for their choices. Three thousand eight hundred forty-eight women who had given birth in the preceding 2 years were interviewed in the census. The odds of institutional prenatal and delivery care increased with education, economic status, and duration of residence in Mumbai, and decreased with parity. Tertiary public hospitals were the commonest site of care, but there was a preference for private hospitals with increasing socio-economic status. Women were more likely to use tertiary public hospitals for delivery if they had fewer children and were Hindu. The odds of delivery in the private sector increased with maternal education, wealth, age, recent arrival in Mumbai, and Muslim faith. Four processes were identified in choosing a health care provider: exploring the options, defining a sphere of access, negotiating autonomy, and protective reasoning. Women seeking a positive health experience and outcome adopted strategies to select the best or most suitable, accessible provider. In Mumbai's informal settlements, institutional maternity care is the norm, except among recent migrants. Poor perceptions of primary public health facilities often cause residents to bypass them in favour of tertiary hospitals or private sector facilities. Families follow a complex selection process, mediated by their ability to mobilise economic and social resources, and a concern for positive experiences of health care and outcomes. Health managers must ensure quality services, a functioning regulatory mechanism, and monitoring of provider behaviour.

  9. Goal setting using telemedicine in rural underserved older adults with diabetes: experiences from the informatics for diabetes education and telemedicine project.

    Science.gov (United States)

    West, Susan P; Lagua, Carina; Trief, Paula M; Izquierdo, Roberto; Weinstock, Ruth S

    2010-05-01

    To describe the use of telemedicine for setting goals for behavior change and examine the success in achieving these goals in rural underserved older adults with diabetes. Medicare beneficiaries with diabetes living in rural upstate New York who were enrolled in the telemedicine intervention of the Informatics for Diabetes Education and Telemedicine (IDEATel) project (n = 610) participated in home televisits with nurse and dietitian educators every 4-6 weeks for 2-6 years. Behavior change goals related to nutrition, physical activity, monitoring, diabetes health maintenance, and/or use of the home telemedicine unit were established at the conclusion of each televisit and assessed at the next visit. Collaborative goal setting was employed during 18,355 televisits (mean of 33 goal-setting televisits/participant). The most common goals were related to monitoring, followed by diabetes health maintenance, nutrition, exercise, and use of the telemedicine equipment. Overall, 68% of behavioral goals were rated as "improved" or "met." The greatest success was achieved for goals related to proper insulin injection technique and daily foot care. These elderly participants had the most difficulty achieving goals related to use of the computer. No gender differences in goal achievement were observed. Televisits can be successfully used to collaboratively establish behavior change goals to help improve diabetes self-management in underserved elderly rural adults.

  10. Differential access to digital communication technology: association with health and health survey recruitment within an African-American underserviced urban population.

    Science.gov (United States)

    Schneider, John; Makelarski, Jennifer A; Van Haitsma, Martha; Lipton, Rebecca B; Abramsohn, Emily; Lauderdale, Diane S; Lindau, Stacy Tessler

    2011-06-01

    Digital communication technologies (DCT), such as cell phones and the internet, have begun to replace more traditional technologies even in technology-poor communities. We characterized access to DCT in an underserved urban population and whether access is associated with health and study participation. A general probability community sample and a purposive high-turnover housing sample were recruited and re-interviewed after 3 months. Selected characteristics were compared by sample type and retention. Associations between DCT access and self-reported health were examined using multivariable logistic regression. Of 363 eligible individuals, 184 (general community = 119; high-turnover housing = 65) completed the baseline survey. Eighty-four percent of respondents had a cell phone and 62% had ever texted. Ever use of the internet was high (69%) overall, but frequency and years of internet use were higher in the general community sample. Self-reported fair or poor health was more common for residents of cell phone-only households and those with less frequent internet use. Technology use was similar for those retained and not retained. Overall, access to DCT was high in this underserved urban population but varied by sample type. Health varied significantly by DCT use, but study retention did not. These data have implications for incorporating DCT into health-related research in urban populations.

  11. Giving Voice to the Medically Under-Served: A Qualitative Co-Production Approach to Explore Patient Medicine Experiences and Improve Services to Marginalized Communities.

    Science.gov (United States)

    Latif, Asam; Tariq, Sana; Abbasi, Nasa; Mandane, Baguiasri

    2018-01-27

    With an aging population, the appropriate, effective and safe use of medicines is a global health priority. However, "'medically under-served" patients continue to experience significant inequalities around access to healthcare services. This study forms part of a wider project to co-develop and evaluate a digital educational intervention for community pharmacy. The aim of this paper is to explore the medicine needs of patients from marginalized communities and suggest practical way on how services could be better tailored to their requirements. Following ethical approval, qualitative data was gathered from: (1) workshops with patients and professionals ( n = 57 attendees); and (2) qualitative semi-structured interviews (10 patients and 10 pharmacists). Our findings revealed that patients from marginalized communities reported poor management of their medical conditions and significant problems with adherence to prescribed medicines. Their experience of pharmacy services was found to be variable with many experiencing discrimination or disadvantage as a result of their status. This study highlights the plight of medically under-served communities and the need for policy makers to tailor services to an individual's needs and circumstances. Furthermore, patients and professionals can work in collaboration using a co-production approach to develop educational interventions for pharmacy service improvements.

  12. Control Areas

    Data.gov (United States)

    Department of Homeland Security — This feature class represents electric power Control Areas. Control Areas, also known as Balancing Authority Areas, are controlled by Balancing Authorities, who are...

  13. Mobile and portable dental services catering to the basic oral health needs of the underserved population in developing countries: a proposed model.

    Science.gov (United States)

    Ganavadiya, R; Chandrashekar, Br; Goel, P; Hongal, Sg; Jain, M

    2014-05-01

    India is the second most populous country in the world with an extensive rural population (68.8%). Children less than 18 years constitute about 40% of the population. Approximately, 23.5% of the urban population resides in urban slums. The extensive rural population, school children and the urban slum dwellers are denied of even the basic dental services though there is continuous advancement in the field of dentistry. The dentist to population ratio has dramatically improved in the last one to two decades with no significant improvement in the oral health status of the general population. The various studies have revealed an increasing trend in oral diseases in the recent times especially among this underserved population. Alternate strategies have to be thought about rather than the traditional oral health-care delivery through private dentists on fee for service basis. Mobile and portable dental services are a viable option to take the sophisticated oral health services to the doorsteps of the underserved population. The databases were searched for publications from 1900 to the present (2013) using terms such as Mobile dental services, Portable dental services and Mobile and portable dental services with key articles obtained primarily from MEDLINE. This paper reviews the published and unpublished literature from different sources on the various mobile dental service programs successfully implemented in some developed and developing countries. Though the mobile and portable systems have some practical difficulties like financial considerations, they still seem to be the only way to reach every section of the community in the absence of national oral health policy and organized school dental health programs in India. The material for the present review was obtained mainly by searching the biomedical databases for primary research material using the search engine with key words such as mobile and/or portable dental services in developed and developing countries

  14. Mobile and Portable Dental Services Catering to the Basic Oral Health Needs of the Underserved Population in Developing Countries: A Proposed Model

    Science.gov (United States)

    Ganavadiya, R; Chandrashekar, BR; Goel, P; Hongal, SG; Jain, M

    2014-01-01

    India is the second most populous country in the world with an extensive rural population (68.8%). Children less than 18 years constitute about 40% of the population. Approximately, 23.5% of the urban population resides in urban slums. The extensive rural population, school children and the urban slum dwellers are denied of even the basic dental services though there is continuous advancement in the field of dentistry. The dentist to population ratio has dramatically improved in the last one to two decades with no significant improvement in the oral health status of the general population. The various studies have revealed an increasing trend in oral diseases in the recent times especially among this underserved population. Alternate strategies have to be thought about rather than the traditional oral health-care delivery through private dentists on fee for service basis. Mobile and portable dental services are a viable option to take the sophisticated oral health services to the doorsteps of the underserved population. The databases were searched for publications from 1900 to the present (2013) using terms such as Mobile dental services, Portable dental services and Mobile and portable dental services with key articles obtained primarily from MEDLINE. This paper reviews the published and unpublished literature from different sources on the various mobile dental service programs successfully implemented in some developed and developing countries. Though the mobile and portable systems have some practical difficulties like financial considerations, they still seem to be the only way to reach every section of the community in the absence of national oral health policy and organized school dental health programs in India. The material for the present review was obtained mainly by searching the biomedical databases for primary research material using the search engine with key words such as mobile and/or portable dental services in developed and developing countries

  15. Stories From the Field: The Use of Information and Communication Technologies to Address the Health Needs of Underserved Populations in Latin America and the Caribbean.

    Science.gov (United States)

    Farach, Nasim; Faba, Gladys; Julian, Soroya; Mejía, Felipe; Cabieses, Báltica; D'Agostino, Marcelo; Cortinois, Andrea A

    2015-01-01

    As their availability grew exponentially in the last 20 years, the use of information and communication technologies (ICT) in health has been widely espoused, with many emphasizing their potential to decrease health inequities. Nonetheless, there is scarce availability of information regarding ICT as tools to further equity in health, specifically in Latin American and Caribbean settings. Our aim was to identify initiatives that used ICT to address the health needs of underserved populations in Latin America and Caribbean. Among these projects, explore the rationale behind the selection of ICT as a key component, probe perceptions regarding contributions to health equity, and describe the challenges faced during implementation. We conducted an exploratory qualitative study. Interviews were completed via Skype or face-to-face meetings using a semistructured interview guide. Following participant consent, interviews were audio recorded and verbatim transcriptions were developed. All transcriptions were coded using ATLASti7 software. The text was analyzed for patterns, shared themes, and diverging opinions. Emerging findings were reviewed by all interviewers and shared with participants for feedback. We interviewed representatives from eight organizations in six Latin American and Caribbean countries that prominently employed ICT in health communication, advocacy, or surveillance projects. ICT expanded project's geographic coverage, increased their reach into marginalized or hard-to-reach groups, and allowed real-time data collection. Perceptions of contributions to health equity resided mainly in the provision of health information and linkage to health services to members of groups experiencing greater morbidity because of poverty, remote place of residence, lack of relevant public programs, and/or stigma and discrimination, and in more timely responses by authorities to the health needs of these groups as a result of the increased availability of strategic

  16. Do health information technology self-management interventions improve glycemic control in medically underserved adults with diabetes? A systematic review and meta-analysis.

    Science.gov (United States)

    Heitkemper, Elizabeth M; Mamykina, Lena; Travers, Jasmine; Smaldone, Arlene

    2017-09-01

    The purpose of this systematic review and meta-analysis was to examine the effect of health information technology (HIT) diabetes self-management education (DSME) interventions on glycemic control in medically underserved patients. Following an a priori protocol, 5 databases were searched. Studies were appraised for quality using the Cochrane Risk of Bias assessment. Studies reporting either hemoglobin A1c pre- and post-intervention or its change at 6 or 12 months were eligible for inclusion in the meta-analysis using random effects models. Thirteen studies met the criteria for the systematic review and 10 for the meta-analysis and represent data from 3257 adults with diabetes (mean age 55 years; 66% female; 74% racial/ethnic minorities). Most studies ( n  = 10) reflected an unclear risk of bias. Interventions varied by HIT type: computer software without Internet ( n  = 2), cellular/automated telephone ( n  = 4), Internet-based ( n  = 4), and telemedicine/telehealth ( n  = 3). Pooled A1c decreases were found at 6 months (-0.36 (95% CI, -0.53 and -0.19]; I 2  = 35.1%, Q  = 5.0), with diminishing effect at 12 months (-0.27 [95% CI, -0.49 and -0.04]; I 2  = 42.4%, Q  = 10.4). Findings suggest that medically underserved patients with diabetes achieve glycemic benefit following HIT DSME interventions, with dissipating but significant effects at 12 months. Telemedicine/telehealth interventions were the most successful HIT type because they incorporated interaction with educators similar to in-person DSME. These results are similar to in-person DSME in medically underserved patients, showing that well-designed HIT DSME has the potential to increase access and improve outcomes for this vulnerable group. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  17. A novel educational strategy targeting health care workers in underserved communities in Central America to integrate HIV into primary medical care.

    Science.gov (United States)

    Flys, Tamara; González, Rosalba; Sued, Omar; Suarez Conejero, Juana; Kestler, Edgar; Sosa, Nestor; McKenzie-White, Jane; Monzón, Irma Irene; Torres, Carmen-Rosa; Page, Kathleen

    2012-01-01

    Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs). We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities. The training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions. Of 258 initially active participants, 225 (225/258=87.2%) successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200=85%) attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (pstructure, and effectiveness in improving their HIV-related knowledge and skills. This innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills acquired through the process, and could continue working within their underserved communities while participating in the online component and then implement interventions that successfully converted theoretical knowledge to action to improve integration of HIV care into primary care.

  18. Effects of a culturally tailored physical activity promotion program on selected self-regulation skills and attitudes in adolescents of an underserved, multiethnic milieu.

    Science.gov (United States)

    Laberge, Suzanne; Bush, Paula Louise; Chagnon, Miguel

    2012-01-01

    To implement a culturally tailored physical activity (PA) promotion program (FunAction) and to assess its impact on five self-regulation skills and attitudes in adolescents. Design . The design and implementation of the FunAction program were informed by social marketing principles. The study used a quasi-experimental approach to assess the impact of the program on specific outcome variables. A multiethnic, underserved middle school in Montreal, Quebec, Canada. The intervention group was made up of grade 8 students (n  =  165) and the control group was made up of grade 7 students (n  =  137). During the 16-week intervention, adolescents were able to choose from a variety of 45-minute cardiovascular PAs offered daily during their school lunch period. Adolescents participated in the activities on a voluntary basis. A self-report questionnaire was administered preintervention and postintervention to measure adolescents' scores on the following self-regulation skills and attitudes: self-control, self-esteem, attention/concentration, social competence, and interethnic relationships. Three-way repeated measures analyses of variance and correlational analyses were used. Results . A significant improvement was observed only in attention/concentration. Girls' attention/concentration scores improved significantly in the intervention group compared to the control group (F(1,127)  =  16.26, p marketing principles can help encourage adolescents from underserved, multiethnic milieus to participate in PA during their school lunch hour. Furthermore, voluntary participation in a culturally tailored PA program can improve youths' attention/concentration.

  19. ‘Much clearer with pictures’: using community-based participatory research to design and test a Picture Option Grid for underserved patients with breast cancer

    Science.gov (United States)

    Durand, Marie-Anne; Alam, Shama; Grande, Stuart W; Elwyn, Glyn

    2016-01-01

    Objective Women of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer. Design Community-based participatory research (CBPR) using think-aloud protocols (phases 1 and 2) and semistructured interviews (phase 3). Setting Underserved community settings (eg, knitting groups, bingo halls, senior centres) and breast clinics. Participants In phase 1, we recruited a convenience sample of clinicians and academics. In phase 2, we targeted women over 40 years of age, of low SES, regardless of breast cancer history, and in phase 3, women of low SES, recently diagnosed with breast cancer. Intervention The pictorial encounter decision aid was derived from an evidence-based table comparing treatment options for breast cancer (http://www.optiongrid.org). Outcome measures We assessed the usability, acceptability and accessibility of the pictorial decision aid prototypes using the think-aloud protocol and semistructured interviews. Results After initial testing of the first prototype with 18 academics and health professionals, new versions were developed and tested with 53 lay individuals in community settings. Usability was high. In response to feedback indicating that the use of cartoon characters was considered insensitive, a picture-only version was developed and tested with 23 lay people in phase 2, and 10 target users in phase 3. Conclusions and relevance Using CBPR methods and iterative user testing cycles improved usability and accessibility, and led to the development of the Picture Option Grid, entirely guided by multiple stakeholder feedback. All women of low SES recently diagnosed with early stage breast

  20. Tribological influence of tool surface roughness within microforming

    DEFF Research Database (Denmark)

    Eriksen, Rasmus Solmer; Weidel, S.; Hansen, Hans Nørgaard

    2010-01-01

    A comparative friction study of tooling dies with a simple internal cylindrical geometry has been performed. The purpose of the experiment consist of studying the influence of the surface characteristics of tooling dies on the frictional behaviour in a micro bulk forming operation. This research ...

  1. A Guide to the Microform Collections of the USMA Library.

    Science.gov (United States)

    1980-01-01

    the Renaissance and the Elizabethian period. One may find the earliest editions of Chaucer, Spenser, Shakespeare , More, Erasumus, and Bacon. Military...laws. As a companion to its indexing and abstracting services, CIS provides a comprehensive collection of contemporary government documents on

  2. Correlation between vegetation pattern and microtopography in periglacial areas of the Central Alps

    Directory of Open Access Journals (Sweden)

    Gerdol, Renato

    1990-06-01

    Full Text Available The distributional patterns of plant species were analyzed within periglacial microforms belonging to the collective groups of patterned grounds and sorted stripes In the Ortles-Cevedale group (Lombardy, Italy. The edges of primitive polygons are practically free of vegetation, whilst the central areas are colonized by pioneer plants of detritic slopes. This is clearly correlated with a low degree of sediment sorting. The morphological evolution of the forms proceeds at a faster rate at the edge of polygons than in the central areas. Vegetation, on the other hand, colonizes the coarse debris at the polygons’ edges slowly but colonizes the fine material in the central areas actively. The centre of the most evolved polygons is covered by a carpet of Salix herbacea. Age determinations of Salix shoots are not useful for dating purposes, but provide Information about the local microclimate.

    [es] Se han analizado los modelos de distribución de especies vegetales en microformas periglaciares pertenecientes al tipo de suelos estructurales en el Ortles-Cevedale (Lombardía, Italia. Los límites de los polígonos de piedras están prácticamente libres de vegetación, mientras las áreas centrales están colonizadas por plantas pioneras de laderas pedregosas. La evolución morfológica actúa a mayor velocidad en el borde de los polígonos que en las áreas centrales. Por otro lado, la vegetación coloniza lentamente los bordes de los polígonos, y más activamente las zonas centrales. El centro de la mayoría de los polígonos está cubierto por un manto de Salix herbacea. La determinación de la edad de los vástagos de Salix no ha sido un método útil a efectos cronológicos, pero proporciona información sobre el microclima local.
    [fr] On étude les modèles de distribution d'espèces végétaux dans microformes périglaciaires appartenants au type de sols structurales dans l'Ortles-Cevedale (Lombardie

  3. A novel educational strategy targeting health care workers in underserved communities in Central America to integrate HIV into primary medical care.

    Directory of Open Access Journals (Sweden)

    Tamara Flys

    Full Text Available BACKGROUND: Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs. We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities. METHODS: The training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions. RESULTS: Of 258 initially active participants, 225 (225/258=87.2% successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200=85% attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (p<0.001. The mean pre- and post-test scores evaluating clinical knowledge were 70.9% and 90.3%, respectively, with an increase in knowledge of 19.4% (p<0.001. A survey of Likert scale and open-ended questions demonstrated overwhelming participant satisfaction with course content, structure, and effectiveness in improving their HIV-related knowledge and skills. CONCLUSION: This innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills

  4. The Engineering 4 Health Challenge - an interdisciplinary and intercultural initiative to foster student engagement in B.C. and improve health care for children in under-serviced communities.

    Science.gov (United States)

    Price, Morgan; Weber-Jahnke, Jens H

    2009-01-01

    This paper describes the Engineering 4 Health (E4H) Challenge, an interdisciplinary and intercultural initiative that, on the one hand, seeks to improve health education of children in under-serviced communities and, on the other, seeks to attract students in British Columbia to professions in engineering and health. The E4H Challenge engages high school and university students in BC to cooperatively design and develop health information and communication technology (ICT) to educate children living in under-serviced communities. The E4H Challenge works with the One Laptop Per Child (OLPC) program to integrate applications for health awareness into the school programs of communities in developing countries. Although applications developed by the E4H Challenge use the low-cost, innovative XO laptop (the "$100 laptop" developed by the OLPC foundation) the software can also be used with other inexpensive hardware.

  5. Anchorage Areas

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — An anchorage area is a place where boats and ships can safely drop anchor. These areas are created in navigable waterways when ships and vessels require them for...

  6. The Effect of Volunteering at a Student-Run Free Healthcare Clinic on Medical Students' Self-Efficacy, Comfortableness, Attitude, and Interest in Working with the Underserved Population and Interest in Primary Care.

    Science.gov (United States)

    Tran, Kelvin; Kovalskiy, Aleksandr; Desai, Anand; Imran, Amna; Ismail, Rahim; Hernandez, Caridad

    2017-02-23

    The number of primary care physicians in the United States continues to lag behind the number of uninsured people. There has been a growing demand for medical students to improve their self-efficacy, comfortableness, attitude, and interest in working with the underserved and in primary care. This study aims to discern whether volunteering at a student-run, free healthcare clinic has a positive impact on these five variables of interest or not. A 95-item survey was distributed through Qualtrics Survey Software (Qualtrics, Provo, UT, USA) to medical students from the Class of 2018 and Class of 2019 at the University of Central Florida College of Medicine. They were recruited via emails, Facebook, and in-classroom announcements. Mean responses on a Likert-like scale to different survey items were collected and compared between two study cohorts: Keeping Neighbors In Good Health Through Service (KNIGHTS) Clinic volunteers and non-volunteers. Results from 128 students showed no significant differences in the means between the two cohorts (p-values were not significant). When volunteers were asked the survey item, "KNIGHTS Clinic positively influenced my attitude towards working with underserved patients," 62% strongly agreed, 26% agreed, 10% were neutral, and 2% disagreed. Based on the results, volunteering at KNIGHTS Clinic may not have a positive impact on the five variables of interest. However, the lack of significance may also be due to certain limitations of this study addressed elsewhere in this paper. With the majority of KNIGHTS Clinic volunteers agreeing that "KNIGHTS Clinic positively influenced […their] attitude towards working with underserved patients," there may be a positive impact of volunteering on volunteers' attitude towards working with the underserved.

  7. Building an argument for Internet expansion in Dwesa- an under-serviced rural community in South Africa

    CSIR Research Space (South Africa)

    Dlamini, S

    2014-11-01

    Full Text Available The purpose of this paper is to present research findings that investigate the extent of Internet usage as well as options for extending the current reach of the wireless network in Dwesa, a rural area in South Africa’s Eastern Cape Province. A mix...

  8. Relationships Between Health Literacy and Genomics-Related Knowledge, Self-Efficacy, Perceived Importance, and Communication in a Medically Underserved Population.

    Science.gov (United States)

    Kaphingst, Kimberly A; Blanchard, Melvin; Milam, Laurel; Pokharel, Manusheela; Elrick, Ashley; Goodman, Melody S

    2016-01-01

    The increasing importance of genomic information in clinical care heightens the need to examine how individuals understand, value, and communicate about this information. Based on a conceptual framework of genomics-related health literacy, we examined whether health literacy was related to knowledge, self-efficacy, and perceived importance of genetics and family health history (FHH) and communication about FHH in a medically underserved population. The analytic sample was composed of 624 patients at a primary care clinic in a large urban hospital. About half of the participants (47%) had limited health literacy; 55% had no education beyond high school, and 58% were Black. In multivariable models, limited health literacy was associated with lower genetic knowledge (β = -0.55, SE = 0.10, p interval [CI; 0.28, 0.90], p = .020), and greater perceived importance of genetic information (OR = 1.95, 95% CI [1.27, 3.00], p = .0022) but lower perceived importance of FHH information (OR = 0.47, 95% CI [0.26, 0.86], p = .013) and more frequent communication with a doctor about FHH (OR = 2.02, 95% CI [1.27, 3.23], p = .0032). The findings highlight the importance of considering domains of genomics-related health literacy (e.g., knowledge, oral literacy) in developing educational strategies for genomic information. Health literacy research is essential to avoid increasing disparities in information and health outcomes as genomic information reaches more patients.

  9. The 50/50 cc Total Artificial Heart Trial: Extending the Benefits of the Total Artificial Heart to Underserved Populations.

    Science.gov (United States)

    Wells, Dennis; Villa, Chet R; Simón Morales, David Luís

    2017-01-01

    While use of the total artificial heart (TAH) is growing, the use of the device is not uniform across the gender and age spectrum because the vast majority of implants are in adult males. SynCardia has recently developed a smaller 50 cc TAH that was designed to accommodate patients with a body surface area as low as 1.2 m 2 (potentially even lower using virtual implantation). Herein, we describe the early use of the 50 cc TAH (10 implants in the US and 18 outside the US). Twenty-eight devices have been implanted worldwide. Nineteen (68%) patients were female, 4 (14%) were 21 years of age or younger, and 2 (7%) had a diagnosis of congenital heart disease (1 Fontan). The smallest patient, by body surface area, was 1.35 m 2 . Six patients (21%) have been placed on the Freedom Driver, all of whom have survived. Fourteen patients (50%) have had a positive outcome to date. The development of the 50 cc TAH has expanded the population of patients who may benefit from TAH support and thus may help improve outcomes for patients who have had limited biventricular support options to date. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Increasing Research Capacity in Underserved Communities: Formative and Summative Evaluation of the Mississippi Community Research Fellows Training Program (Cohort 1

    Directory of Open Access Journals (Sweden)

    Danielle Fastring

    2018-02-01

    Full Text Available BackgroundThe Mississippi Community Research Fellows Training Program (MSCRFTP is a 15-week program conducted in Jackson, MS, USA consisting of training in the areas of evidence-based public health, research methods, research ethics, and cultural competency. The purpose of the program was to increase community knowledge and understanding of public health research, develop community-based projects that addressed health disparity in the participants’ community, increase individual and community capacity, and to engage community members as equal partners in the research process.MethodsA comprehensive evaluation of the MSCRFTP was conducted that included both quantitative and qualitative methods. All participants were asked to complete a baseline, midterm, and final assessment as part of their program requirements. Knowledge gained was assessed by comparing baseline assessment responses to final assessment responses related to 27 key content areas addressed in the training sessions. Assessments also collected participants’ attitudes toward participating in research within their communities, their perceived influence over community decisions, and their perceptions of community members’ involvement in research, satisfaction with the program, and the program’s impact on the participants’ daily practice and community work.ResultsTwenty-one participants, the majority of which were female and African-American, completed the MSCRFTP. Knowledge of concepts addressed in 15 weekly training sessions improved significantly on 85.2% of 27 key areas evaluated (p < 0.05. Two mini-grant community based participatory research projects proposed by participants were funded through competitive application. Most participants agreed that by working together, the people in their community could influence decisions that affected the community. All participants rated their satisfaction with the overall program as “very high” (76.2%, n = 16 or

  11. Revitalization Areas

    Data.gov (United States)

    Department of Housing and Urban Development — Revitalization areas are HUD-designated neighborhoods in need of economic and community development and where there is already a strong commitment by the local...

  12. 700 Area

    Data.gov (United States)

    Federal Laboratory Consortium — The 700 Area of the Hanford Site is located in downtown Richland.Called the Federal Office Building, the Richland Operations Site Manager and the Richland Operations...

  13. Budget Impact Analysis of Against Colorectal Cancer In Our Neighborhoods (ACCION): A Successful Community-Based Colorectal Cancer Screening Program for a Medically Underserved Minority Population.

    Science.gov (United States)

    Kim, Bumyang; Lairson, David R; Chung, Tong Han; Kim, Junghyun; Shokar, Navkiran K

    2017-06-01

    Given the uncertain cost of delivering community-based cancer screening programs, we developed a Markov simulation model to project the budget impact of implementing a comprehensive colorectal cancer (CRC) prevention program compared with the status quo. The study modeled the impacts on the costs of clinical services, materials, and staff expenditures for recruitment, education, fecal immunochemical testing (FIT), colonoscopy, follow-up, navigation, and initial treatment. We used data from the Against Colorectal Cancer In Our Neighborhoods comprehensive CRC prevention program implemented in El Paso, Texas, since 2012. We projected the 3-year financial consequences of the presence and absence of the CRC prevention program for a hypothetical population cohort of 10,000 Hispanic medically underserved individuals. The intervention cohort experienced a 23.4% higher test completion rate for CRC prevention, 8 additional CRC diagnoses, and 84 adenomas. The incremental 3-year cost was $1.74 million compared with the status quo. The program cost per person was $261 compared with $86 for the status quo. The costs were sensitive to the proportion of high-risk participants and the frequency of colonoscopy screening and diagnostic procedures. The budget impact mainly derived from colonoscopy-related costs incurred for the high-risk group. The effectiveness of FIT to detect CRC was critically dependent on follow-up after positive FIT. Community cancer prevention programs need reliable estimates of the cost of CRC screening promotion and the added budget impact of screening with colonoscopy. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  14. The Regional Asthma Disease Management Program (RADMP) for low income underserved children in rural western North Carolina: a National Asthma Control Initiative Demonstration Project.

    Science.gov (United States)

    Shuler, Melinda S; Yeatts, Karin B; Russell, Donald W; Trees, Amy S; Sutherland, Susan E

    2015-01-01

    A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI). This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management. Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month pre-intervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p < 0.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25-75 increased by 7.2%, 13.2% and 21.1%, respectively (all p < 0.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882,021. The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.

  15. Parent-child reading interactions among English and English as a second language speakers in an underserved pediatric clinic in Hawai'i.

    Science.gov (United States)

    Kitabayashi, Kristyn M; Huang, Gary Y; Linskey, Katy R; Pirga, Jason; Bane-Terakubo, Teresa; Lee, Meta T

    2008-10-01

    The purpose of this study was to compare reading patterns between English-speaking and English as a Second Language (ESL) families in a health care setting in Hawai'i. A cross-sectional study was performed at an underserved pediatric primary care clinic in Hawai'i. Caregivers of patients between the ages of 6 months to 5 years were asked questions regarding demographics and parent-child reading interactions. Respondents were categorized into English-speaking or ESL groups based on primary language spoken at home. Pearson chi2 tests and Fisher exact tests were performed to compare demographic differences, reading frequency, and reading attitudes between groups. One-hundred three respondents completed the survey Fifty percent were ESL. All ESL respondents were of Asian-Pacific Islander (API) or mixed Asian ethnicity. All Caucasians in the study (n = 9) were in the English-speaking group. Between the English-speaking (n = 52) and ESL (n = 51) groups, there were no significant statistical differences in age or gender of the child, reading attitudes, or parent's educational status. Parents in the ESL group read to their children significantly fewer days per week than their English-speaking counterparts, had significantly fewer books in the home, and lived significantly fewer years in the United States. The findings suggest that API immigrant families share similar attitudes about reading as English-speaking families in Hawai'i but have significantly fewer books in their household and read significantly less frequently Physicians working with API populations should be aware that immigrant children may have fewer reading interactions and should counsel parents on the importance of reading daily.

  16. Identifying Telemedicine Services to Improve Access to Specialty Care for the Underserved in the San Francisco Safety Net

    Directory of Open Access Journals (Sweden)

    Ken Russell Coelho

    2011-01-01

    Full Text Available Safety-net settings across the country have grappled with providing adequate access to specialty care services. San Francisco General Hospital and Trauma Center, serving as the city's primary safety-net hospital, has also had to struggle with the same issue. With Healthy San Francisco, the City and County of San Francisco's Universal Healthcare mandate, the increased demand for specialty care services has placed a further strain on the system. With the recent passage of California Proposition 1D, infrastructural funds are now set aside to assist in connecting major hospitals with primary care clinics in remote areas all over the state of California, using telemedicine. Based on a selected sample of key informant interviews with local staff physicians, this study provides further insight into the current process of e-referral which uses electronic communication for making referrals to specialty care. It also identifies key services for telemedicine in primary and specialty care settings within the San Francisco public health system. This study concludes with proposals for a framework that seek to increase collaboration between the referring primary care physician and specialist, to prioritize institution of these key services for telemedicine.

  17. Comparison of small-area deprivation measures as predictors of chronic disease burden in a low-income population.

    Science.gov (United States)

    Lòpez-De Fede, Ana; Stewart, John E; Hardin, James W; Mayfield-Smith, Kathy

    2016-06-10

    Measures of small-area deprivation may be valuable in geographically targeting limited resources to prevent, diagnose, and effectively manage chronic conditions in vulnerable populations. We developed a census-based small-area socioeconomic deprivation index specifically to predict chronic disease burden among publically insured Medicaid recipients in South Carolina, a relatively poor state in the southern United States. We compared the predictive ability of the new index with that of four other small-area deprivation indicators. To derive the ZIP Code Tabulation Area-Level Palmetto Small-Area Deprivation Index (Palmetto SADI), we evaluated ten census variables across five socioeconomic deprivation domains, identifying the combination of census indicators most highly correlated with a set of five chronic disease conditions among South Carolina Medicaid enrollees. In separate validation studies, we used both logistic and spatial regression methods to assess the ability of Palmetto SADI to predict chronic disease burden among state Medicaid recipients relative to four alternative small-area socioeconomic deprivation measures: the Townsend index of material deprivation; a single-variable poverty indicator; and two small-area designations of health care resource deprivation, Primary Care Health Professional Shortage Area and Medically Underserved Area/Medically Underserved Population. Palmetto SADI was the best predictor of chronic disease burden (presence of at least one condition and presence of two or more conditions) among state Medicaid recipients compared to all alternative deprivation measures tested. A low-cost, regionally optimized socioeconomic deprivation index, Palmetto SADI can be used to identify areas in South Carolina at high risk for chronic disease burden among Medicaid recipients and other low-income Medicaid-eligible populations for targeted prevention, screening, diagnosis, disease self-management, and care coordination activities.

  18. Quiet areas

    DEFF Research Database (Denmark)

    Petersen, Rikke Munck

    2016-01-01

    This paper argues that drone filming can substantiate our understanding of multisensorial experiences of quiet areas and urban landscapes. Contrary to the distanced gaze often associated with the drone, this paper discusses drone filming as an intimate performativity apparatus that can affect...... perception as a result of its interrelationships between motion, gaze, and sound. This paper uses four films, one of which is a drone flyover, to launch a discussion concerning a smooth and alluring gaze, a sliding gaze that penetrates landscapes, and site appearance. Films hold the capacity to project both...... and transcendence can facilitate a deeper understanding of intimate sensations, substantiating their role in the future design and planning of urban landscapes. Hence, it addresses the ethics of an intimacy perspective (of drone filming) in the qualification of quiet areas....

  19. Children's Healthy Living (CHL) Program for remote underserved minority populations in the Pacific region: rationale and design of a community randomized trial to prevent early childhood obesity.

    Science.gov (United States)

    Wilken, Lynne R; Novotny, Rachel; Fialkowski, Marie K; Boushey, Carol J; Nigg, Claudio; Paulino, Yvette; Leon Guerrero, Rachael; Bersamin, Andrea; Vargo, Don; Kim, Jang; Deenik, Jonathan

    2013-10-09

    's Healthy Living Program environmental trial is designed to focus on capacity building and to maximize the likelihood of sustainable impact on childhood obesity-related behaviors and outcomes. The multiple measures at the individual, community, and environment levels are designed to maximize the likelihood of detecting change. This approach enhances the likelihood for identifying and promoting the best methods to promote health and well-being of the children in the underserved US Affiliated Pacific Region. NIH clinical trial # NCT01881373.

  20. Partnered Evaluation of a Community Engagement Intervention: Use of a “Kickoff” Conference in a Randomized Trial for Depression Care Improvement in Underserved Communities

    Science.gov (United States)

    Mendel, Peter; Ngo, Victoria K.; Dixon, Elizabeth; Stockdale, Susan; Jones, Felica; Chung, Bowen; Jones, Andrea; Masongsong, Zoe; Khodyakov, Dmitry

    2013-01-01

    Community partnered research and engagement strategies are gaining recognition as innovative approaches to improving healthcare systems and reducing health disparities in underserved communities. These strategies may have particular relevance for mental health interventions in low income, minority communities in which there often is great stigma and silence surrounding conditions such as depression and difficulty in implementing improved access and quality of care. At the same time, there is a relative dearth of evidence on the effectiveness of specific community engagement interventions and on the design, process, and context of these interventions necessary for understanding their implementation and generalizability. This paper evaluates one of a number of community engagement strategies employed in the Community Partners in Care (CPIC) study, the first randomized controlled trial of the role of community engagement in adapting and implementing evidence-based depression care. We specifically describe the unique goals and features of a community engagement “kickoff” conference as used in CPIC and provide evidence on the effectiveness of this type of intervention by analyzing its impact on: 1) stimulating a dialogue, sense of collective efficacy, and opportunities for learning and networking to address depression and depression care in the community, 2) activating interest and participation in CPIC’s randomized trial of two different ways to implement evidence-based quality improvement (QI) programs for depression across diverse community agencies, and 3) introducing evidence-based toolkits and collaborative care models to potential participants in both intervention conditions and other community members. We evaluated the effectiveness of the conference through a community-partnered process in which both community and academic project members were involved in study design, data collection and analysis. Data sources include participant conference evaluation

  1. The eCALM Trial-eTherapy for cancer appLying mindfulness: online mindfulness-based cancer recovery program for underserved individuals living with cancer in Alberta: protocol development for a randomized wait-list controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Zernicke Kristin A

    2013-02-01

    Full Text Available Abstract Background Elevated stress can exacerbate cancer symptom severity, and after completion of primary cancer treatments, many individuals continue to have significant distress. Mindfulness-Based Cancer Recovery (MBCR is an 8-week group psychosocial intervention consisting of training in mindfulness meditation and yoga designed to mitigate stress, pain, and chronic illness. Efficacy research shows face-to-face (F2F MBCR programs have positive benefits for cancer patients; however barriers exist that impede participation in F2F groups. While online MBCR groups are available to the public, none have been evaluated. Primary objective: determine whether underserved patients are willing to participate in and complete an online MBCR program. Secondary objectives: determine whether online MBCR will mirror previous efficacy findings from F2F MBCR groups on patient-reported outcomes. Method/design The study includes cancer patients in Alberta, exhibiting moderate distress, who do not have access to F2F MBCR. Participants will be randomized to either online MBCR, or waiting for the next available group. An anticipated sample size of 64 participants will complete measures online pre and post treatment or waiting period. Feasibility will be tracked through monitoring numbers eligible and participating through each stage of the protocol. Discussion 47 have completed/completing the intervention. Data suggest it is possible to conduct a randomized waitlist controlled trial of online MBCR to reach underserved cancer survivors. Trial registration Clinical Trials.gov Identifier: NCT01476891

  2. Area Health Education Center (AHEC) programs for rural and underrepresented minority students in the Alabama Black Belt.

    Science.gov (United States)

    Patel, Ashruta; Knox, Regina J; Logan, Alicia; Summerville, Katie

    2017-01-01

    This paper evaluated the implementation West Central Alabama Area Health Education Center programs for high school students in grades 9-12 through participant-reported evaluations and feedback during the  September 1st, 2013 to August 31st, 2014 fiscal year. The programs targeted racial/ethnic minorities and/or rural individuals interested in pursuing a career as a healthcare provider in medically underserved counties of Alabama. Students participated in enrichment activities related to prospective health careers that included: successful college preparedness, knowledge about health careers, and the types of primary care health professions that are needed in underserved Alabama communities. The curriculum studied 593 (ACT preparation: n  = 172, AHEC 101: n  = 56, FAFSA: n  = 109, Health Career Exploration: n  = 159, College Career Readiness: n  = 67, Dixie Scholars NERD: n  = 30) baseline measures for the programs to evaluate effectiveness when rated by participants both quantitatively and qualitatively. Interactive activities with video incorporation, hands-on experiences, and group discussions paired with student motivation and interest in specific health career-related activities provided the highest program ratings. It is important to use a variety of successful program strategies when forming healthcare workforce development interventions. Student evaluations can help adapt methods for future program implementation to ultimately achieve strategies for health professional recruitment, training, and retention in areas that lack access to quality healthcare.

  3. Telemedicine in rural areas: general practitioners’ representations and experiences

    Science.gov (United States)

    Durupt, Maxime; Bouchy, Olivier; Christophe, Sonia; Kivits, Joëlle; Boivin, Jean-Marc

    2016-10-19

    Introduction: Telemedicine is a rapidly growing new mode of healthcare practice. It is particularly used and needed in remote areas in Lorraine (North East of France) that currently face a shortage of general practitioners and specialists. The objective of this study was to analyse general practitioner’s representations of telemedicine and teleconsultation. The study also identified the advantages and disadvantages of this new mode of medical practice. Methods: A qualitative research was led: 5 focus groups were conducted with 32 doctors in areas faced with the problems of health professional shortages between June 2014 and July 2015. Results: This study reveals a general ignorance of telemedicine. Doctors want to play a central role in this new form of medical practice which must remain optional. Their reluctance essentially concerns financial and legal aspects that constitute obstacles to the development of telemedicine. Finally, this new mode of medical practice must comply with a legal framework regarding medical responsibility and personal data protection. Discussion.More than 100 medical procedures are delivered by telemedicine in Lorraine each month. This new technology is a solution to provide healthcare services in medically underserved areas. However, general practitioners want to preserve the “doctor-patient” relationship and do not wish to change their practice.

  4. Using a Learning Activity Sequence in Large-Enrollment Physical Geology Classes: Supporting the Needs of Underserved Students While Motivating Interest, Learning, and Success

    Science.gov (United States)

    Pun, A.; Smith, G. A.

    2011-12-01

    The learning activity sequence (LAS) strategy is a student-focused pedagogy that emphasizes active classroom learning to promote learning among all students, and in particular, those with diverse backgrounds. Online assessments both set the stage for active learning and help students synthesize material during their learning. UNM is one of only two Carnegie Research University Very High institutions also designated as Hispanic-serving and the only state flagship university that is also a majority-minority undergraduate institution. In 2010 Hispanics comprised 40% of 20,655 undergraduates (and 49% of freshmen), 37% of undergraduates were Pell Grant recipients (the largest proportion of any public flagship research university; J. Blacks Higher Ed., 2009) and 44% of incoming freshmen were first-generation students. To maximize student learning in this environment rich in traditionally underserved students, we designed a LAS for nonmajor physical geology (enrollments 100-160) that integrates in-class instruction with structured out-of-class learning. The LAS has 3 essential parts: Students read before class to acquire knowledge used during in-class collaborative, active-learning activities that build conceptual understanding. Lastly, students review notes and synthesize what they've learned before moving on to the next topic. The model combines online and in-class learning and assessment: Online reading assessments before class; active-learning experiences during class; online learning assessments after class. Class sessions include short lectures, peer instruction "clickers", and small-group problem solving (lecture tutorials). Undergraduate Peer-Learning Facilitators are available during class time to help students with problem solving. Effectiveness of the LAS approach is reflected in three types of measurements. (1) Using the LAS strategy, the overall rate of students earning a grade of C or higher is higher than compared to the average for all large

  5. A Behavioral Lifestyle Intervention Enhanced With Multiple-Behavior Self-Monitoring Using Mobile and Connected Tools for Underserved Individuals With Type 2 Diabetes and Comorbid Overweight or Obesity: Pilot Comparative Effectiveness Trial.

    Science.gov (United States)

    Wang, Jing; Cai, Chunyan; Padhye, Nikhil; Orlander, Philip; Zare, Mohammad

    2018-04-10

    Self-monitoring is a cornerstone of behavioral lifestyle interventions for obesity and type 2 diabetes mellitus. Mobile technology has the potential to improve adherence to self-monitoring and patient outcomes. However, no study has tested the use of a smartphone to facilitate self-monitoring in overweight or obese adults with type 2 diabetes mellitus living in the underserved community. The aim of this study was to examine the feasibility of and compare preliminary efficacy of a behavioral lifestyle intervention using smartphone- or paper-based self-monitoring of multiple behaviors on weight loss and glycemic control in a sample of overweight or obese adults with type 2 diabetes mellitus living in underserved communities. We conducted a randomized controlled trial to examine the feasibility and preliminary efficacy of a behavioral lifestyle intervention. Overweight or obese patients with type 2 diabetes mellitus were recruited from an underserved minority community health center in Houston, Texas. They were randomly assigned to one of the three groups: (1) behavior intervention with smartphone-based self-monitoring, (2) behavior intervention with paper diary-based self-monitoring, and (3) usual care group. Both the mobile and paper groups received a total of 11 face-to-face group sessions in a 6-month intervention. The mobile group received an Android-based smartphone with 2 apps loaded to help them record their diet, physical activity, weight, and blood glucose, along with a connected glucometer, whereas the paper group used paper diaries for these recordings. Primary outcomes of the study included percentage weight loss and glycated hemoglobin (HbA 1c ) changes over 6 months. A total of 26 patients were enrolled: 11 in the mobile group, 9 in the paper group, and 6 in the control group. We had 92% (24/26) retention rate at 6 months. The sample is predominantly African Americans with an average age of 56.4 years and body mass index of 38.1. Participants lost an

  6. Evaluation of community provision of a preventive cardiovascular programme - the National Health Service Health Check in reaching the under-served groups by primary care in England: cross sectional observational study.

    Science.gov (United States)

    Woringer, Maria; Cecil, Elizabeth; Watt, Hillary; Chang, Kiara; Hamid, Fozia; Khunti, Kamlesh; Dubois, Elizabeth; Evason, Julie; Majeed, Azeem; Soljak, Michael

    2017-06-14

    Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England's National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups. Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs). We assessed variation between local authorities in terms of age, sex, deprivation and ethnicity structures using two sample t-tests and within local authority variation in terms of ethnicity and deprivation using Chi squared tests and two sample t-tests respectively. Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p successful in recruiting ethnic minority groups. The mean proportion of men screened was 11.39% lower (p successful in motivating the under-served groups to improve lifestyle, it may reduce health inequalities therein.

  7. Stated preferences of doctors for choosing a job in rural areas of Peru: a discrete choice experiment.

    Directory of Open Access Journals (Sweden)

    J Jaime Miranda

    Full Text Available Doctors' scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors' stated preferences for rural jobs.A labelled discrete choice experiment (DCE was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho's capital and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54. Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%.Doctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden.

  8. Class 1 Areas

    Data.gov (United States)

    U.S. Environmental Protection Agency — A "Class 1" area is a geographic area recognized by the EPA as being of the highest environmental quality and requiring maximum protection. Class I areas are areas...

  9. Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: a quasi-experimental intervention study.

    NARCIS (Netherlands)

    Meuwissen, L.E.; Gorter, A.C.; Knottnerus, A.J.A.

    2006-01-01

    BACKGROUND: The objective of this study was to evaluate a competitive voucher program intended to make sexual and reproductive health care (SRHC) accessible to adolescents from disadvantaged areas of Managua. METHODS: A quasi-experimental intervention study was performed in which 28,711 vouchers

  10. Assessment of a government-subsidized supermarket in a high-need area on household food availability and children's dietary intakes.

    Science.gov (United States)

    Elbel, Brian; Moran, Alyssa; Dixon, L Beth; Kiszko, Kamila; Cantor, Jonathan; Abrams, Courtney; Mijanovich, Tod

    2015-10-01

    To assess the impact of a new government-subsidized supermarket in a high-need area on household food availability and dietary habits in children. A difference-in-difference study design was utilized. Two neighbourhoods in the Bronx, New York City. Outcomes were collected in Morrisania, the target community where the new supermarket was opened, and Highbridge, the comparison community. Parents/caregivers of a child aged 3-10 years residing in Morrisania or Highbridge. Participants were recruited via street intercept at baseline (pre-supermarket opening) and at two follow-up periods (five weeks and one year post-supermarket opening). Analysis is based on 2172 street-intercept surveys and 363 dietary recalls from a sample of predominantly low-income minorities. While there were small, inconsistent changes over the time periods, there were no appreciable differences in availability of healthful or unhealthful foods at home, or in children's dietary intake as a result of the supermarket. The introduction of a government-subsidized supermarket into an underserved neighbourhood in the Bronx did not result in significant changes in household food availability or children's dietary intake. Given the lack of healthful food options in underserved neighbourhoods and need for programmes that promote access, further research is needed to determine whether healthy food retail expansion, alone or with other strategies, can improve food choices of children and their families.

  11. A community-based breast cancer screening program for medically underserved women: its effect on disease stage at diagnosis and on hazard of death Programa basado en la comunidad de tamizaje de cáncer de mama en mujeres médicamente subatendidas: efecto sobre el estadio de la enfermedad en el momento del diagnóstico y el riesgo de muerte

    Directory of Open Access Journals (Sweden)

    Clyde B. McCoy

    2004-03-01

    Full Text Available OBJECTIVE: Earlier studies by this research team found that medically underserved minority women in the Miami-Dade County area of the state of Florida, United States, were in need of breast cancer screening and that there were problems with availability, accessibility, and acceptability of services. In response, a community-based comprehensive breast cancer screening program called the Early Detection Program (EDP was developed. The specific purpose of this study was to assess the effect that EDP participation had on stage at diagnosis and on hazard of death. METHODS: Existing data from the Florida Cancer Data System (FCDS, a statewide cancer registry, were linked with data from the EDP. In December 1998 we assembled a multiethnic (African-American, black Hispanic, white Hispanic, and white non-Hispanic retrospective cohort with the following inclusion criteria: all women aged 40 and older with breast cancer diagnosed and staged at University of Miami/Jackson Memorial Medical Center (which is located in the city of Miami, Florida from January 1987 through December 1997. EDP participants were medically underserved, that is, they resided in lower socioeconomic areas and/or had limited or no health insurance to cover medical costs. Subjects identified as EDP participants were compared to nonparticipants with respect to disease stage at diagnosis and hazard of death. Logistic regression and Cox regression models were used for analysis. RESULTS: EDP participants were 2.4 times as likely (95% confidence interval = 1.71 to 3.43 to present with a diagnosis of localized cancer as were nonparticipants, even after controlling for race and age at diagnosis. EDP participation was independently associated with both earlier diagnosis and reduced hazard of death. CONCLUSIONS: Participation in the EDP increases the likelihood of early detection of breast cancer and reduces the hazard of death for medically underserved women in the Miami-Dade County area of

  12. Health Service Areas (HSAs) - Small Area Estimates

    Science.gov (United States)

    Health Service Areas (HSAs) are a compromise between the 3000 counties and the 50 states. An HSA may be thought of as an area that is relatively self-contained with respect to hospital care and may cross over state boundries.

  13. Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Mburu, Grace; George, Gavin

    2017-07-31

    Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. South Africa's HRH strategy for the Health Sector 2012/13-2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.

  14. Prevalence and associated factors of wheezing illnesses of children aged three to five years living in under-served settlements of the Colombo Municipal Council in Sri Lanka: a cross-sectional study.

    Science.gov (United States)

    Seneviratne, Ruwanika; Gunawardena, Nalika S

    2018-01-11

    A rising trend in Sri Lanka for asthma and wheezing illness is observed with higher morbidity in younger children and a paucity of related research. 'Under-served settlements' (USS) of Colombo Municipal Council (CMC) have poor living environments conducive to childhood wheezing. The objective was to describe the prevalence and associated factors of wheezing illnesses of three to five year old children living in low-income settlements in CMC. A cross-sectional study was conducted on 460 three to five year old children and their caregivers using cluster sampling among residents of two randomly selected USSs of CMC. An interviewer-administered questionnaire, observation checklist and data extraction form were used in data collection. A physician's diagnosis of wheezing/whistling of the chest in their lifetime and a physician's diagnosis of wheezing/whistling within the past twelve months were considered as 'ever-wheezing illness' and 'current-wheezing illness' respectively. Mean age was 3.98 years (SD = ±0.64 years). A majority were males (51.3%) and Tamils (39.8%). Prevalence of 'ever wheezing illness' and 'current wheezing illness' were 38% (95% confidence interval (CI); 33.6%-42.5%) and 21.3% (95%CI; 17.6%-25.0%), respectively. Maternal (p settlements was found to be high. Children with a history of maternal and/or paternal wheezing should be targeted for early interventions to prevent wheezing illnesses. Interventions to avoid exacerbations should focus on the indoor environmental factors that were found to be associated with wheezing illnesses.

  15. The Utility of Rural and Underserved Designations in Geospatial Assessments of Distance Traveled to Healthcare Services: Implications for Public Health Research and Practice

    Directory of Open Access Journals (Sweden)

    Matthew Lee Smith

    2013-01-01

    Full Text Available Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1 review the different definitions of rurality and their purposes; (2 identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3 describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4 examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.

  16. The utility of rural and underserved designations in geospatial assessments of distance traveled to healthcare services: implications for public health research and practice.

    Science.gov (United States)

    Smith, Matthew Lee; Dickerson, Justin B; Wendel, Monica L; Ahn, Sangnam; Pulczinski, Jairus C; Drake, Kelly N; Ory, Marcia G

    2013-01-01

    Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.

  17. Should Broca's area include Brodmann area 47?

    Science.gov (United States)

    Ardila, Alfredo; Bernal, Byron; Rosselli, Monica

    2017-02-01

    Understanding brain organization of speech production has been a principal goal of neuroscience. Historically, brain speech production has been associated with so-called Broca’s area (Brodmann area –BA- 44 and 45), however, modern neuroimaging developments suggest speech production is associated with networks rather than with areas. The purpose of this paper was to analyze the connectivity of BA47 ( pars orbitalis) in relation to language . A meta-analysis was conducted to assess the language network in which BA47 is involved. The Brainmap database was used. Twenty papers corresponding to 29 experimental conditions with a total of 373 subjects were included. Our results suggest that BA47 participates in a “frontal language production system” (or extended Broca’s system). The BA47  connectivity found is also concordant with a minor role in language semantics. BA47 plays a central role in the language production system.

  18. Infrastructure Area Simplification Plan

    CERN Document Server

    Field, L.

    2011-01-01

    The infrastructure area simplification plan was presented at the 3rd EMI All Hands Meeting in Padova. This plan only affects the information and accounting systems as the other areas are new in EMI and hence do not require simplification.

  19. VT ZIP Code Areas

    Data.gov (United States)

    Vermont Center for Geographic Information — (Link to Metadata) A ZIP Code Tabulation Area (ZCTA) is a statistical geographic entity that approximates the delivery area for a U.S. Postal Service five-digit...

  20. Vermont Designated Natural Areas

    Data.gov (United States)

    Vermont Center for Geographic Information — Under Natural Areas Law (10 Vermont Statutes Annotated, Chapter 83 � 2607) the FPR commissioner, with the approval of the governor, may designate and set aside areas...

  1. Hydrologic Areas of Concern

    Data.gov (United States)

    University of New Hampshire — A Hydrologic Area of Concern (HAC) is a land area surrounding a water source, which is intended to include the portion of the watershed in which land uses are likely...

  2. Reform in the dental services area in Romania – objective necessity or second option

    Directory of Open Access Journals (Sweden)

    Cristian UŢĂ

    2011-09-01

    Full Text Available The article herein deals with a topic of current interest, not only because the latest economic and social phenomena within the context of globalized crisis in the world, but also from the perspective of the evolution and specific processes in the medical area in Romania. The writer accomplishes a journey into the various medical systems in national economies, by analyzing the features of each type of system and the opportunity for a ‘capitalist’ vision related to the healthcare services in general. The dental medical services share a series of characteristics that help them be better defined from the point of view of provider-customer relation. Thus, it becomes evident that, for Romania, the process initiated in 2006 meaning liberalization of practicing the dental doctor profession represents a natural way of developing the market specific to such services. From this perspective, this issue targets the mentalities level only – to impose quality standards on the market and to witness the offer-demand balance, both deriving from the specific nature itself of the dental services. The involvement of the authorities at Health Department into developing a health insurance policy in the dental field and the support of the private initiative in the underserved areas are the main targets of the ‘reform’.

  3. A Guide to the Microform Collections of the USMA (United States Military Academy) Library,

    Science.gov (United States)

    1983-01-01

    period. One may find the earliest editions of Chaucer, Spenser, Shakespeare , More, Erasumus, and Bacon. Military, legal, royal and other public...Information Service, Inc., provides reference and information retrieval services to Congressional publications and public lava. As a companion to its

  4. Children’s Healthy Living (CHL) Program for remote underserved minority populations in the Pacific region: rationale and design of a community randomized trial to prevent early childhood obesity

    Science.gov (United States)

    2013-01-01

    ) framework. Discussion The Children’s Healthy Living Program environmental trial is designed to focus on capacity building and to maximize the likelihood of sustainable impact on childhood obesity-related behaviors and outcomes. The multiple measures at the individual, community, and environment levels are designed to maximize the likelihood of detecting change. This approach enhances the likelihood for identifying and promoting the best methods to promote health and well-being of the children in the underserved US Affiliated Pacific Region. Trial registration NIH clinical trial # NCT01881373 PMID:24107083

  5. SUGARLOAF ROADLESS AREA, CALIFORNIA.

    Science.gov (United States)

    Powell, Robert E.; Campbell, Harry W.

    1984-01-01

    On the basis of geologic, geochemical, and geophysical investigations and a survey of mines, quarries, and prospects the Sugarloaf Roadless Area, California, has little promise for the occurrence of metallic mineral or energy resources. Units of carbonate rock and graphitic schist have demonstrated resources of magnesian marble and graphite. Sand, gravel, and construction stone other than carbonate rock are present in the roadless area, but similar or better quality materials are abundant and more accessible outside the area.

  6. Area-level risk factors for adverse birth outcomes: trends in urban and rural settings.

    Science.gov (United States)

    Kent, Shia T; McClure, Leslie A; Zaitchik, Ben F; Gohlke, Julia M

    2013-06-10

    Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban-rural status. Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991-2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching

  7. Aperture area measurement facility

    Data.gov (United States)

    Federal Laboratory Consortium — NIST has established an absolute aperture area measurement facility for circular and near-circular apertures use in radiometric instruments. The facility consists of...

  8. Radon affected areas: Scotland

    International Nuclear Information System (INIS)

    Miles, J.C.H.; Green, B.M.R.; Lomas, P.R.

    1993-01-01

    Board advice on radon in homes issued in 1990 specifies that areas of the UK where 1% or more of homes exceed the Action Level of 200 becquerels per cubic metre of air should be regarded as Affected Areas. Results of radon measurements in homes in the districts of Kincardine and Deeside and Gordon in Grampian Region and Caithness and Sutherland in Highland Region are mapped and used to delineate Affected Areas in these areas where required. The Scottish Office is advised to consider the desirability of developing guidance on precautions against radon in future homes. (author)

  9. Fishing Access Areas

    Data.gov (United States)

    Vermont Center for Geographic Information — The Vermont Fish & Wildlife Department maintains developed fishing access areas. These sites provide public access to waters in Vermont for shore fishing...

  10. CVP Service Area

    Data.gov (United States)

    California Natural Resource Agency — Federal Water Contract Service Area boundaries are incorporated boundaries of districts having contracts with the U.S. Bureau of Reclamation (Reclamation), within...

  11. Opportunities in Honors for Underserved Students

    Science.gov (United States)

    Pattillo, Baker

    2015-01-01

    First-generation students sometimes lack a support network that values higher education. Stephen F. Austin State University (SFA)--a regional, comprehensive university of approximately 13,000 students, located in East Texas--serves a diverse body of students who are nearly 50% first-generation. These students often face financial constraints and…

  12. Cervical Cancer Screening in Underserved Populations

    Centers for Disease Control (CDC) Podcasts

    Dr. Lisa Flowers, a specialist in human papillovarius (HPV)-related diseases and Director of Colposcopy at Emory University School of Medicine, talks about cervical cancer screening in underinsured or uninsured women.

  13. Increasing Cervical Cancer Screening in Underserved Populations.

    Science.gov (United States)

    Dorsainvil, Merlyn A

    The incidence of cervical cancer has declined dramatically due to Papanicolaou smear testing. However, some minority populations continue to suffer with high incidences and/or death rates of cervical cancer, due to lack of screening. This article updates on cervical cancer screening and prevention and discusses cultural impacts on screening. Knowledge deficits disproportionately affect ethnic minority groups and contribute to cancer incidence, whereas lack of healthcare coverage and low socioeconomic status contribute to screening disparities. Although minority women have cultural beliefs and practices that influence screening, recommendation and/or education from a provider often lead to screening.

  14. Cervical Cancer Screening in Underserved Populations

    Centers for Disease Control (CDC) Podcasts

    2009-10-15

    Dr. Lisa Flowers, a specialist in human papillovarius (HPV)-related diseases and Director of Colposcopy at Emory University School of Medicine, talks about cervical cancer screening in underinsured or uninsured women.  Created: 10/15/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Cancer Prevention and Control (DCPC).   Date Released: 6/9/2010.

  15. Quadrilaterals: Diagonals and Area

    Science.gov (United States)

    McGraw, Rebecca

    2017-01-01

    The task shared in this article provides geometry students with opportunities to recall and use basic geometry vocabulary, extend their knowledge of area relationships, and create area formulas. It is characterized by reasoning and sense making (NCTM 2009) and the "Construct viable arguments and critique the reasoning of others"…

  16. Operational Area Environmental Evaluations

    Energy Technology Data Exchange (ETDEWEB)

    Bailey-White, Brenda Eileen [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Nagy, Michael David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Wagner, Katrina Marie [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Goodman, Thomas Richard [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Herring, Allen [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Catechis, Christopher S. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Kinghorn, Aubrianna Nicole [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Johnson, Ellie [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Barthel, Michael David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Casaus, Benito [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-08-01

    The Operational Area Environmental Evaluation update provides a description of activities that have the potential to adversely affect natural and cultural resources, including soil, air, water, biological, ecological, and historical resources. The environmental sensitivity of an area is evaluated and summarized, which may facilitate informed management decisions as to where development may be prohibited, restricted, or subject to additional requirements.

  17. The Introduction of a Supermarket via Tax-Credits in a Low-Income Area.

    Science.gov (United States)

    Elbel, Brian; Mijanovich, Tod; Kiszko, Kamila; Abrams, Courtney; Cantor, Jonathan; Dixon, L Beth

    2017-01-01

    Interest and funding continue to grow for bringing supermarkets to underserved areas, yet little is known about their impact. A quasi-experimental study was used to determine the impact of a new supermarket opening as a result of tax and zoning incentives. The study took place in the South Bronx, New York City, New York. Studied were residents of two South Bronx neighborhoods deemed high need. Food purchasing and consumption were examined via surveys and 24-hour dietary recalls before and at two points after the supermarket opened (1-5, 13-17 months). Data were analyzed using difference-in-difference models controlling for gender, race and ethnicity, age, education, marital status, and self-reported income. Ordinary least squares and logistic regression models were estimated for continuous and binary outcomes, respectively. At baseline, 94% to 97% of consumers shopped at a supermarket. There was a 2% increase in this behavior in the intervention community ( p supermarket did not result in substantial or broad changes in purchasing patterns or nutritional quality of food consumed, though smaller, positive changes were observed over a 1-year period. Future work should examine different contexts and a broader set of outcomes, including economic development.

  18. Electric Holding Company Areas

    Data.gov (United States)

    Department of Homeland Security — Holding companies are electric power utilities that have a holding company structure. This vector polygon layer represents the area served by electric power holding...

  19. Urban Greening Bay Area

    Science.gov (United States)

    Information about the San Francisco Bay Water Quality Project (SFBWQP) Urban Greening Bay Area, a large-scale effort to re-envision urban landscapes to include green infrastructure (GI) making communities more livable and reducing stormwater runoff.

  20. Semi-arid Areas

    International Development Research Centre (IDRC) Digital Library (Canada)

    Livia Bizikova

    precipitation in the form of rainfall or snow (UN, 2011; MEA 2009). • Dryland subtypes can ... in terms of their land uses: rangelands, croplands, and urban areas. ... farmers; climate resilient agricultural practices; irrigation, pasture management.

  1. Ice Engineering Research Area

    Data.gov (United States)

    Federal Laboratory Consortium — Refrigerated Physical Modeling of Waterways in a Controlled EnvironmentThe Research Area in the Ice Engineering Facility at the Cold Regions Research and Engineering...

  2. spatially identifying vulnerable areas

    African Journals Online (AJOL)

    The model structure is aimed at understanding the critical vulnerable factors that ... This paper incorporates multiple criteria and rank risk factors. ..... In terms of quantifying vulnerable areas within the country, the analysis is done based on 9 ...

  3. kaduna area, north ce

    African Journals Online (AJOL)

    Admin

    Similarly, the relative variation of depth to the water table inferred from the spectral analysis was used to deduce .... All the image processing and map preparations were done on a .... investigations in shallow basement areas of. Zaria, Kaduna ...

  4. ABACC's nuclear accounting area

    International Nuclear Information System (INIS)

    Nicolas, Ruben O.

    2001-01-01

    The functions and activities of the Brazilian-Argentine Agency for the Accounting and Control of Nuclear Materials (ABACC) accounting area is outlined together with a detailed description of the nuclear accounting system used by the bilateral organization

  5. Pilot Boarding Areas

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Pilot boarding areas are locations at sea where pilots familiar with local waters board incoming vessels to navigate their passage to a destination port. Pilotage is...

  6. Quantifying disbond area

    Science.gov (United States)

    Lowden, D. W.

    1992-10-01

    Disbonds simulated in a composite helicopter rotor blade were profiled using eddy currents. The method is inherently accurate and reproducible. An algorithm is described for calculating disbond margin. Disbond area is estimated assuming in-service disbondments exhibit circular geometry.

  7. Decontamination & decommissioning focus area

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-08-01

    In January 1994, the US Department of Energy Office of Environmental Management (DOE EM) formally introduced its new approach to managing DOE`s environmental research and technology development activities. The goal of the new approach is to conduct research and development in critical areas of interest to DOE, utilizing the best talent in the Department and in the national science community. To facilitate this solutions-oriented approach, the Office of Science and Technology (EM-50, formerly the Office of Technology Development) formed five Focus AReas to stimulate the required basic research, development, and demonstration efforts to seek new, innovative cleanup methods. In February 1995, EM-50 selected the DOE Morgantown Energy Technology Center (METC) to lead implementation of one of these Focus Areas: the Decontamination and Decommissioning (D & D) Focus Area.

  8. PM 10 Nonattainment Areas

    Data.gov (United States)

    U.S. Environmental Protection Agency — This data layer identifies areas in the U.S. where air pollution levels have not met the National Ambient Air Quality Standards (NAAQS) for PM 10 and have been...

  9. Carbon Monoxide Nonattainment Areas

    Data.gov (United States)

    U.S. Environmental Protection Agency — This data layer identifies areas in the U.S. where air pollution levels have not met the National Ambient Air Quality Standards (NAAQS) for Carbon Monoxide and have...

  10. SO2 Nonattainment Areas

    Data.gov (United States)

    U.S. Environmental Protection Agency — This data layer identifies areas in the U.S. where air pollution levels have not met the National Ambient Air Quality Standards (NAAQS) for Sulfur dioxide and have...

  11. Drainage of radioactive areas

    International Nuclear Information System (INIS)

    1981-04-01

    This Code of Practice covers all the drainage systems which may occur in the radioactive classified area of an establishment, namely surface water, foul, process and radioactive drainage. It also deals with final discharge lines. The Code of Practice concentrates on those aspects of drainage which require particular attention because the systems are in or from radioactive areas and typical illustrations are given in appendices. The Code makes references to sources of information on conventional aspects of drainage design. (author)

  12. 300 Area Disturbance Report

    Energy Technology Data Exchange (ETDEWEB)

    LL Hale; MK Wright; NA Cadoret

    1999-01-07

    The objective of this study was to define areas of previous disturbance in the 300 Area of the U.S. Department of Energy (DOE) Hanford Site to eliminate these areas from the cultural resource review process, reduce cultural resource monitoring costs, and allow cultural resource specialists to focus on areas where subsurface disturbance is minimal or nonexistent. Research into available sources suggests that impacts from excavations have been significant wherever the following construction activities have occurred: building basements and pits, waste ponds, burial grounds, trenches, installation of subsurface pipelines, power poles, water hydrants, and well construction. Beyond the areas just mentioned, substrates in the' 300 Area consist of a complex, multidimen- sional mosaic composed of undisturbed stratigraphy, backfill, and disturbed sediments; Four Geographic Information System (GIS) maps were created to display known areas of disturbance in the 300 Area. These maps contain information gleaned from a variety of sources, but the primary sources include the Hanford GIS database system, engineer drawings, and historic maps. In addition to these maps, several assumptions can be made about areas of disturbance in the 300 Area as a result of this study: o o Buried pipelines are not always located where they are mapped. As a result, cultural resource monitors or specialists should not depend on maps depicting subsurface pipelines for accurate locations of previous disturbance. Temporary roads built in the early 1940s were placed on layers of sand and gravel 8 to 12 in. thick. Given this information, it is likely that substrates beneath these early roads are only minimally disturbed. Building foundations ranged from concrete slabs no more than 6 to 8 in. thick to deeply excavated pits and basements. Buildings constructed with slab foundations are more numerous than may be expected, and minimally disturbed substrates may be expected in these locations. Historic

  13. Investigating scintillometer source areas

    Science.gov (United States)

    Perelet, A. O.; Ward, H. C.; Pardyjak, E.

    2017-12-01

    Scintillometry is an indirect ground-based method for measuring line-averaged surface heat and moisture fluxes on length scales of 0.5 - 10 km. These length scales are relevant to urban and other complex areas where setting up traditional instrumentation like eddy covariance is logistically difficult. In order to take full advantage of scintillometry, a better understanding of the flux source area is needed. The source area for a scintillometer is typically calculated as a convolution of point sources along the path. A weighting function is then applied along the path to compensate for a total signal contribution that is biased towards the center of the beam path, and decreasing near the beam ends. While this method of calculating the source area provides an estimate of the contribution of the total flux along the beam, there are still questions regarding the physical meaning of the weighted source area. These questions are addressed using data from an idealized experiment near the Salt Lake City International Airport in northern Utah, U.S.A. The site is a flat agricultural area consisting of two different land uses. This simple heterogeneity in the land use facilitates hypothesis testing related to source areas. Measurements were made with a two wavelength scintillometer system spanning 740 m along with three standard open-path infrared gas analyzer-based eddy-covariance stations along the beam path. This configuration allows for direct observations of fluxes along the beam and comparisons to the scintillometer average. The scintillometer system employed measures the refractive index structure parameter of air for two wavelengths of electromagnetic radiation, 880 μm and 1.86 cm to simultaneously estimate path-averaged heat and moisture fluxes, respectively. Meteorological structure parameters (CT2, Cq2, and CTq) as well as surface fluxes are compared for various amounts of source area overlap between eddy covariance and scintillometry. Additionally, surface

  14. Opportunities and improvisations: a pediatric surgeon's suggestions for successful short-term surgical volunteer work in resource-poor areas.

    Science.gov (United States)

    Meier, Donald

    2010-05-01

    There is a paucity of trained pediatric surgeons in resource-poor areas, and many children never receive care for debilitating problems that could readily be managed by surgeons with proper training, supplies, and instrumentation. This article, written from the perspective of a surgeon who has been both the recipient of and the provider of volunteer surgical services, is intended to encourage surgeons in technologically advanced locations to volunteer in underserved areas and to assist them in the implementation of such endeavors. Concepts are presented with an emphasis on pediatric surgery, but most are relevant for volunteers in all surgical specialties. Volunteer paradigms include, but are not limited to, the "surgical brigade" model, where a large group of health care professionals take all needed equipment and supplies for the duration of their stint, and the "minimalist" model, where a single volunteer works with local personnel using locally available equipment. For a successful volunteer endeavor the host needs to have a perceived need for the volunteer's services, and the volunteer must be flexible in adapting to meet overwhelming needs with limited resources. It is suggested that appropriate technology, such as the inexpensive anal stimulator presented herein, should be employed whenever possible. With proper planning, realistic expectations, and a cooperative and helpful attitude, volunteer trips can be rewarding experiences for both volunteers and host physicians and lead to lasting relationships that improve children's lives globally.

  15. Plutonium focus area

    International Nuclear Information System (INIS)

    1996-08-01

    To ensure research and development programs focus on the most pressing environmental restoration and waste management problems at the U.S. Department of Energy (DOE), the Assistant Secretary for the Office of Environmental Management (EM) established a working group in August 1993 to implement a new approach to research and technology development. As part of this new approach, EM developed a management structure and principles that led to the creation of specific Focus Areas. These organizations were designed to focus the scientific and technical talent throughout DOE and the national scientific community on the major environmental restoration and waste management problems facing DOE. The Focus Area approach provides the framework for intersite cooperation and leveraging of resources on common problems. After the original establishment of five major Focus Areas within the Office of Technology Development (EM-50, now called the Office of Science and Technology), the Nuclear Materials Stabilization Task Group (EM-66) followed the structure already in place in EM-50 and chartered the Plutonium Focus Area (PFA). The following information outlines the scope and mission of the EM, EM-60, and EM-66 organizations as related to the PFA organizational structure

  16. Area Handbook for Syria.

    Science.gov (United States)

    Nyrop, Richard; And Others

    This volume on Syria is one of a series of handbooks prepared by the Foreign Area Studies (FAS) of the American University, designed to be useful to military and other personnel who need a convenient compilation of basic facts about the social, economic, political, and military institutions and practices of various countries. The emphasis is on…

  17. Subsurface contaminants focus area

    International Nuclear Information System (INIS)

    1996-08-01

    The US Department of Enregy (DOE) Subsurface Contaminants Focus Area is developing technologies to address environmental problems associated with hazardous and radioactive contaminants in soil and groundwater that exist throughout the DOE complex, including radionuclides, heavy metals; and dense non-aqueous phase liquids (DNAPLs). More than 5,700 known DOE groundwater plumes have contaminated over 600 billion gallons of water and 200 million cubic meters of soil. Migration of these plumes threatens local and regional water sources, and in some cases has already adversely impacted off-site rsources. In addition, the Subsurface Contaminants Focus Area is responsible for supplying technologies for the remediation of numerous landfills at DOE facilities. These landfills are estimated to contain over 3 million cubic meters of radioactive and hazardous buried Technology developed within this specialty area will provide efective methods to contain contaminant plumes and new or alternative technologies for development of in situ technologies to minimize waste disposal costs and potential worker exposure by treating plumes in place. While addressing contaminant plumes emanating from DOE landfills, the Subsurface Contaminants Focus Area is also working to develop new or alternative technologies for the in situ stabilization, and nonintrusive characterization of these disposal sites

  18. Local Area Networks.

    Science.gov (United States)

    Marks, Kenneth E.; Nielsen, Steven

    1991-01-01

    Discusses cabling that is needed in local area networks (LANs). Types of cables that may be selected are described, including twisted pair, coaxial cables (or ethernet), and fiber optics; network topologies, the manner in which the cables are laid out, are considered; and cable installation issues are discussed. (LRW)

  19. Sensitive Small Area Photometer

    Science.gov (United States)

    Levenson, M. D.

    1970-01-01

    Describes a simple photometer capable of measuring small light intensities over small areas. The inexpensive, easy-to- construct instrument is intended for use in a student laboratory to measure the light intensities in a diffraction experiment from single or multiple slits. Typical experimental results are presented along with the theoretical…

  20. Beyond breeding area management

    DEFF Research Database (Denmark)

    Pedersen, Lykke; Thorup, Kasper; Tøttrup, Anders P.

    Every year, billions of songbirds migrate thousands of kilometres between their European breeding grounds and African overwintering area. As migratory birds are dependent on resources at a number of sites varying in both space and time, they are likely to be more vulnerable to environmental chang...... and provide important information for conservation management of migratory birds....

  1. NWS Marine Forecast Areas

    Science.gov (United States)

    of Commerce Ocean Prediction Center National Oceanic and Atmospheric Administration Analysis & Unified Surface Analysis Ocean Ocean Products Ice & Icebergs NIC Ice Products NAIS Iceberg Analysis Social Media Facebook Twitter YouTube Search Search For Go NWS All NOAA NWS Marine Forecast Areas

  2. Home area networks

    NARCIS (Netherlands)

    Koonen, A.M.J.

    2013-01-01

    This article consists of a collection of slides from the author's conference presentation. Some of the specific areas/topics discussed include: Convergence in home networks, home service scenarios; Home wired network architectures, CapEx and OpEx; Residential Gateway; Optical fiber types;

  3. Italian: Area Background Information.

    Science.gov (United States)

    Defense Language Inst., Washington, DC.

    This booklet has been assembled in order to provide students of Italian with a compact source of cultural information on their target area. Chapters include discussion of: (1) introduction to Italian; (2) origins of the Italian population; (3) geography; (4) history including the Roman Era, the Middle Ages, the Renaissance, the "Risorgimento," and…

  4. Protected areas in mountains

    Directory of Open Access Journals (Sweden)

    Hamilton, L. S.

    2006-12-01

    Full Text Available

    The importance of a global Protected Areas Network in sustaining appropriate mountain development is presented in this paper. Present status of the world’s “official” Protected Areas in the UN List, and the proportion that are in mountain areas, and including international designations (World Heritage and Biosphere Reserves. Current and future challenges in the management of these special areas are also commented.



    El autor destaca la importancia de una Red Mundial de Espacios Protegidos para el desarrollo sostenible de las montañas. Comenta luego el estatus actual de las Áreas Protegidas “oficiales” del Mundo en la Lista de las Naciones Unidas y qué proporción de ellas forma parte de las montañas, sin olvidar las figuras internacionales de protección como Patrimonio de la Humanidad y Reservas de Biosfera. Para terminar, se discuten los problemas de gestión actuales y futuros de estas áreas tan especiales

  5. Subsurface contaminants focus area

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-08-01

    The US Department of Enregy (DOE) Subsurface Contaminants Focus Area is developing technologies to address environmental problems associated with hazardous and radioactive contaminants in soil and groundwater that exist throughout the DOE complex, including radionuclides, heavy metals; and dense non-aqueous phase liquids (DNAPLs). More than 5,700 known DOE groundwater plumes have contaminated over 600 billion gallons of water and 200 million cubic meters of soil. Migration of these plumes threatens local and regional water sources, and in some cases has already adversely impacted off-site rsources. In addition, the Subsurface Contaminants Focus Area is responsible for supplying technologies for the remediation of numerous landfills at DOE facilities. These landfills are estimated to contain over 3 million cubic meters of radioactive and hazardous buried Technology developed within this specialty area will provide efective methods to contain contaminant plumes and new or alternative technologies for development of in situ technologies to minimize waste disposal costs and potential worker exposure by treating plumes in place. While addressing contaminant plumes emanating from DOE landfills, the Subsurface Contaminants Focus Area is also working to develop new or alternative technologies for the in situ stabilization, and nonintrusive characterization of these disposal sites.

  6. Cleanup of contaminated areas

    International Nuclear Information System (INIS)

    Beone, G.; Carbone, A.I.; Zagaroli, M.

    1989-01-01

    The paper deals with the problem of contaminated areas cleanup, in order to eliminate every possible damage for man safety and environment and to site recovery for some utilization, The first step of cleanup operation is site characterization, that is followed by a pianificazion activity for a better definition of staff qualification, technology to be used, protection and prevention instruments for the risks due to contaminants handling. The second section describes the different remedial technologies for contaminated sites. Remedial technologies may be divided into on-site/off-site and in-situ treatments, according to whether materials (waste, soil, water) are moved to another location or not, respectively. Finally, it is outlined that contaminated areas cleanup is a typical multidisciplinary activity because very different competences are required. (author)

  7. Bronchoscopy in Rural Areas?

    Directory of Open Access Journals (Sweden)

    Reidar Berntsen

    2012-01-01

    Full Text Available Quality of bronchoscopy performed by one single pulmonologist in a scarcely populated subarctic area was compared to the guidelines provided by the British Thoracic Society (BTS. 103 patients underwent bronchoscopy. Diagnostic yield was increased to 76.6% when the first bronchoscopy was supplemented by bronchial washing fluid and brush cytology and to 86.7% (BTS guidelines >80% after a second bronchoscopy. Median time from referral to bronchoscopy was 10 days and 8 days from positive bronchoscopy to operative referral to another hospital. 1% of patients that underwent transbronchial lung biopsy had minor complications. One pulmonologist had rate of correct diagnosis based on visible endobronchial tumors that was comparable to the rates of numerous pulmonologists at larger centers performing the same procedure. Time delay was short. Rate of complications was comparable. Bronchoscopy performed by one pulmonologist alone could, in organized settings, be carried out at local hospitals in areas of scattered settlement.

  8. Hanford Area 2000 Population

    International Nuclear Information System (INIS)

    Elliott, Douglas B.; Scott, Michael J.; Antonio, Ernest J.; Rhoads, Kathleen

    2004-01-01

    This report was prepared for the U.S. Department of Energy (DOE) Richland Operations Office, Surface Environmental Surveillance Project, to provide demographic data required for ongoing environmental assessments and safety analyses at the DOE Hanford Site near Richland, Washington. This document includes 2000 Census estimates for the resident population within an 80-kilometer (50-mile) radius of the Hanford Site. Population distributions are reported relative to five reference points centered on meteorological stations within major operating areas of the Hanford Site - the 100 F, 100 K, 200, 300, and 400 Areas. These data are presented in both graphical and tabular format, and are provided for total populations residing within 80 km (50 mi) of the reference points, as well as for Native American, Hispanic and Latino, total minority, and low-income populations

  9. Geoconservation and protected areas

    OpenAIRE

    Brilha, J. B.

    2002-01-01

    Conservation will fail if nature conservation policies impose artificial boundaries on the natural world. The protected area manager’s main task is biodiversity preservation. Nevertheless, nature conservation requires a broad perspective. Incorporating geology into conservation policies at the same level as biology is urgent. The slow rate of many geological processes leads to the misconception that geological resources are inexhaustible and immutable. Geologists know that this is not true an...

  10. Local area networking handbook

    OpenAIRE

    O'Hara, Patricia A.

    1990-01-01

    Approved for public release; distribution is unlimited. This thesis provides Navy shore based commands with sufficient information on local area networking to (1) decide if they need a LAN, (2) determine what their networking requirements are, and (3) select a LAN that satisfies their requirements. LAN topologies, transmission media, and medium access methods are described. In addition, the OSI reference model for computer networking and the IEEE 802 LAN standards are explained in detail. ...

  11. Defense Technology Area Plan.

    Science.gov (United States)

    1996-05-01

    Concepts for aircraft interior decon • Concepts for wide area/fixed site decon • Supercritical fluid-based decon for sensitive equipment; •Demo enzymatic ...and special purpose clothing; improved closure systems for ensembles; microencapsulated phase change materials for special purpose applications, and...development of microencapsulated phase change materials for heating and cooling in response to extreme temperature changes. Participants in this work are

  12. Frostbites in circumpolar areas

    Directory of Open Access Journals (Sweden)

    Tiina Maria Ikäheimo

    2011-10-01

    Full Text Available Circumpolar areas are associated with prolonged cold exposure where wind, precipitation, and darkness further aggravate the environmental conditions and the associated risks. Despite the climate warming, cold climatic conditions will prevail in circumpolar areas and contribute to adverse health effects. Frostbite is a freezing injury where localized damage affects the skin and other tissues. It occurs during occupational or leisure-time activities and is common in the general population among men and women of various ages. Industries of the circumpolar areas where frostbite occurs frequently include transportation, mining, oil, and gas industry, construction, agriculture, and military operations. Cold injuries may also occur during leisure-time activities involving substantial cold exposure, such as mountaineering, skiing, and snowmobiling. Accidental situations (occupational, leisure time often contribute to adverse cooling and cold injuries. Several environmental (temperature, wind, wetness, cold objects, and altitude and individual (behavior, health, and physiology predisposing factors are connected with frostbite injuries. Vulnerable populations include those having a chronic disease (cardiovascular, diabetes, and depression, children and the elderly, or homeless people. Frostbite results in sequelae causing different types of discomfort and functional limitations that may persist for years. A frostbite injury is preventable, and hence, unacceptable from a public health perspective. Appropriate cold risk management includes awareness of the adverse effects of cold, individual adjustment of cold exposure and clothing, or in occupational context different organizational and technical measures. In addition, vulnerable population groups need customized information and care for proper prevention of frostbites.

  13. All Conservation Opportunity Areas (ECO.RES.ALL_OP_AREAS)

    Data.gov (United States)

    U.S. Environmental Protection Agency — The All_OP_Areas GIS layer are all the Conservation Opportunity Areas identified by MoRAP (produced for EPA Region 7). They designate areas with potential for...

  14. Large area bulk superconductors

    Science.gov (United States)

    Miller, Dean J.; Field, Michael B.

    2002-01-01

    A bulk superconductor having a thickness of not less than about 100 microns is carried by a polycrystalline textured substrate having misorientation angles at the surface thereof not greater than about 15.degree.; the bulk superconductor may have a thickness of not less than about 100 microns and a surface area of not less than about 50 cm.sup.2. The textured substrate may have a thickness not less than about 10 microns and misorientation angles at the surface thereof not greater than about 15.degree.. Also disclosed is a process of manufacturing the bulk superconductor and the polycrystalline biaxially textured substrate material.

  15. Small Area Fair Market Rent

    Data.gov (United States)

    Department of Housing and Urban Development — Due to the increasing demand for more localized rents for a variety of purposes, HUD is making Small Area FMRs for all metropolitan areas available. Small Area FMRs...

  16. Underserved parents, underserved youth: Considering foster parent willingness to foster substance-using adolescents

    Science.gov (United States)

    Meyers, Kathleen; Kaynak, Övgü; Clements, Irene; Bresani, Elena; White, Tammy

    2014-01-01

    Adolescents involved with foster care are five times more likely to receive a drug dependence diagnosis when compared to adolescents in the general population. Prior research has shown that substance use is often hidden from providers, negating any chance for treatment and almost guaranteeing poor post-foster care outcomes. There are virtually no studies that examine the willingness (and its determinants) to foster youth with substance abuse problems. The current study conducted a nationally-distributed survey of 752 currently licensed foster care parents that assessed willingness to foster youth overall and by type of drug used, and possible correlates of this decision (e.g., home factors, system factors, and individual foster parent factors such as ratings of perceived difficulty in fostering this population). Overall, willingness to foster a youth involved with alcohol and other drugs (AOD) was contingent upon the types of drugs used. The odds that a parent would foster an AOD-involved youth were significantly increased by being licensed as a treatment foster home, having fostered an AOD-involved youth in the past, having AOD-specific training and past agency-support when needed, and self-efficacy with respect to positive impact. Surprisingly, when religion played a large part in the decision to foster any child, the odds of willingness to foster an AOD-involved youth dropped significantly. These results suggest that a large proportion of AOD-involved youth who find themselves in the foster care system will not have foster families willing to parent them, thereby forcing placement into a variety of congregate care facilities (e.g., residential treatment facilities, group homes). Specific ways in which the system can address these issues to improve placement and permanency efforts is provided. PMID:25878368

  17. Forging successful academic-community partnerships with community health centers: the California statewide Area Health Education Center (AHEC) experience.

    Science.gov (United States)

    Fowkes, Virginia; Blossom, H John; Mitchell, Brenda; Herrera-Mata, Lydia

    2014-01-01

    Increased access to insurance under the Affordable Care Act will increase demands for clinical services in community health centers (CHCs). CHCs also have an increasingly important educational role to train clinicians who will remain to practice in community clinics. CHCs and Area Health Education Centers (AHECs) are logical partners to prepare the health workforce for the future. Both are sponsored by the Health Resources and Services Administration, and they share a mission to improve quality of care in medically underserved communities. AHECs emphasize the educational side of the mission, and CHCs the service side. Building stronger partnerships between them can facilitate a balance between education and service needs.From 2004 to 2011, the California Statewide AHEC program and its 12 community AHECs (centers) reorganized to align training with CHC workforce priorities. Eight centers merged into CHC consortia; others established close partnerships with CHCs in their respective regions. The authors discuss issues considered and approaches taken to make these changes. Collaborative innovative processes with program leadership, staff, and center directors revised the program mission, developed common training objectives with an evaluation plan, and defined organizational, functional, and impact characteristics for successful AHECs in California. During this planning, centers gained confidence as educational arms for the safety net and began collaborations with statewide programs as well as among themselves. The AHEC reorganization and the processes used to develop, strengthen, and identify standards for centers forged the development of new partnerships and established academic-community trust in planning and implementing programs with CHCs.

  18. Sociodemographic Factors Associated With Trans*female Youth's Access to Health Care in the San Francisco Bay Area.

    Science.gov (United States)

    Johns, Elizabeth A; Jin, Harry; Auerswald, Colette L; Wilson, Erin C

    2017-08-01

    Trans*female youth (TFY) are an underserved population at risk for a variety of poor health outcomes, in part related to barriers to accessing health and mental health care. We conducted a secondary analysis of data collected with 250 TFY aged 16-24 years in the San Francisco Bay Area from 2012 to 2014. Logistic regression was used to test associations between sociodemographic variables and barriers to gender identity-based medical and mental health care. Having a history of unstable housing was associated with significantly higher odds of problems accessing both medical care (odds ratio: 2.16, 95% confidence interval: 1.12-4.13) and mental health care due to gender identity (odds ratio 2.65, 95% confidence interval: 1.08-6.45). Conversely, identifying as genderqueer/genderfluid, Latina, or living in dependent housing was associated with access to either medical or mental health care. Interventions are needed to address housing and discrimination barring access to health care among TFY. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  19. Wide area monitoring study

    International Nuclear Information System (INIS)

    Wogman, N.A.; Holdren, G.R. Jr.

    1999-01-01

    Environmental sampling can be used to complement the safeguarding of nuclear material, especially in the detection of undeclared nuclear activities. Routine monitoring of nuclear installations has provided valuable information about the fate of key signature materials within different environmental settings. The approach collates information regarding the generation of individual radiochemical signatures within different nuclear processes, the potential for release of these signatures to the environment and, the chemical form and mobility of the signatures in environmental media along which the material could migrate. Meteorological, geological and hydrological information is used to determine where to sample, what to sample, and how often to sample to provide the greatest likelihood for detection. Multiple strategies can be used to implement wide area monitoring for safeguards purposes. The most complex, and expensive of these, involves establishing extensive networks of fixed location sampling sites. The sites would be operated continuously, and would be instrumented with automated sampling, analysis, and communication equipment to relay information regarding potential anomalies to control centers in near-real time. Alternative strategies can be used to supplement fixed location monitoring equipment, especially in regions that cannot support (financially or logistically) the fixed stations. Through combinations of these various strategies, using a variety of environmental media to monitor a region, we believe that a competent network, one with a quantifiable probability for detecting undeclared nuclear activities, can be designed. While this approach cannot and should not replace other inspection and monitoring activities, it can potentially contribute valuable information to an international safeguards system. (author)

  20. MANAGEMENT IN RURAL AREAS

    Directory of Open Access Journals (Sweden)

    Danimir Štros

    2015-07-01

    Full Text Available Croatia has been seeking to achive pre-war results in tourism since its independence. Rural tourism in Croatia based on family farma faces a number of problems legal foundations, the involement of local communities, inadequate entepreneur support etc. The political will for development exists, but there is lack of willingness and the ability to get things started, which results in the closure of family farma who cannot cope with the parallel job of agriculture and tourism. Arriving guests certainly want a new type of tourism: peace, clean environment, cultural intangible and tangible treasures, all without the noise and stress; and Croatia can definitely offer it, either in coastal or inland areas with traditional food and drinks. The destinations connection is not satisfactora. there is also an evident lack of legislation and regional spatial development plans for sustainable tourism which is a prerequisite for successful tourism. With these plans presumptins accepted, Croatian tourism would become distinctive and inland and coastal branches of tourism could complement each other so that the customer can spend his vacation both in the continental ant the maritime part of the country, getting to know our culture and enjoy the traditional cousine.

  1. Shielding in experimental areas

    International Nuclear Information System (INIS)

    Stevens, A.; Tarnopolsky, G.; Thorndike, A.; White, S.

    1979-01-01

    The amount of shielding necessary to protect experimental detectors from various sources of background radiation is discussed. As illustrated an experiment has line of sight to sources extending approx. 90 m upstream from the intersection point. Packing a significant fraction of this space with shielding blocks would in general be unacceptable because primary access to the ring tunnel is from the experimental halls. (1) From basic machine design considerations and the inherent necessity to protect superconducting magnets it is expected that experimental areas in general will be cleaner than at any existing accelerator. (2) Even so, it will likely be necessary to have some shielding blocks available to protect experimental apparatus, and it may well be necessary to have a large amount of shielding available in the WAH. (3) Scraping will likely have some influence on all halls, and retractable apparatus may sometimes be necessary. (4) If access to any tunnel is needed to replace a magnet, one has 96 h (4 days) available to move shielding away to permit access without additional downtime. This (the amount of shielding one can shuffle about in 96 h) is a reasonable upper limit to shielding necessary in a hall

  2. 28 CFR 90.16 - Availability and allocation of funds.

    Science.gov (United States)

    2010-07-01

    ... programs in the population and geographic area to be served in relation to the availability of such...), underserved racial or ethnic populations, including Indian populations, and populations underserved because of...

  3. Reclamation of urban areas

    International Nuclear Information System (INIS)

    Roed, J.

    1986-02-01

    A literature study was conducted in order to compare the effectiveness and cost of different reclamation procedures that may be employed after an accident on a nuclear facility takes place in which radioactive material is released to the atmosphere. A substantial amount of work has been done on reclaming soil and snow-covered surfaces. Using scrapers or other soil-moving equipment decontamination factors are 10-100. (The decontamination factor is the ratio of the contamination before to that after the decontamination procedure). However, information on decontamination of paved areas by simple methods such as firehosing and vacuum sweeping are poorly documented. Therefore, only a very uncertain figure in the range 2-10 can be given for the decontamination factor here. It is recommended that a major effort be made in the future to investigate the efficiency of these simple methods, because of their relatively low cost. Also, more expensive methods for reducing the dose such as vacuuming, road planing and deep plowing are treated because of their feasibility under certain circumstances. Using these methods dose reduction factors in the 2-100 range can be obtained. Very expensive techniques, such as sandblasting, water cannon, flame spalling, etc. are justifiable usable only in special situations and are therefore considered very briefly here. The methods vary widely in cost. A simple method like vacuum sweeping costs $0.004 per square meter of surface; whereas one like road planing can reach $4 per square meter. A more sophisticated technique like flame spalling costs as much as $100 per square meter. (author)

  4. Water Service Areas - Public Water Supplier's (PWS) Service Areas

    Data.gov (United States)

    NSGIC Education | GIS Inventory — Boundaries of current public water supplier's (PWS) service areas. This data set contains the present service area boundary of the water system and does not contain...

  5. [Syntactic Processing in Broca's Area: Brodmann Areas 44 and 45].

    Science.gov (United States)

    Yamada, Atora; Sakai, Kuniyoshi L

    2017-04-01

    Brodmann areas 44 and 45 are known as Broca's area; however, their true functional roles are still unknown. Recent developments in neuroimaging techniques revealed the structures and functions of Broca's area in detail. More specifically regarding language functions, sufficient evidence has been accumulated that this region subserves the center of syntactic processing, not necessarily motor functions. Here, we review a role of Broca's area as the grammar center, including other roles in nonlinguistic functions.

  6. Flow area optimization in point to area or area to point flows

    International Nuclear Information System (INIS)

    Ghodoossi, Lotfollah; Egrican, Niluefer

    2003-01-01

    This paper deals with the constructal theory of generation of shape and structure in flow systems connecting one point to a finite size area. The flow direction may be either from the point to the area or the area to the point. The formulation of the problem remains the same if the flow direction is reversed. Two models are used in optimization of the point to area or area to point flow problem: cost minimization and revenue maximization. The cost minimization model enables one to predict the shape of the optimized flow areas, but the geometric sizes of the flow areas are not predictable. That is, as an example, if the area of flow is a rectangle with a fixed area size, optimization of the point to area or area to point flow problem by using the cost minimization model will only predict the height/length ratio of the rectangle not the height and length itself. By using the revenue maximization model in optimization of the flow problems, all optimized geometric aspects of the interested flow areas will be derived as well. The aim of this paper is to optimize the point to area or area to point flow problems in various elemental flow area shapes and various structures of the flow system (various combinations of elemental flow areas) by using the revenue maximization model. The elemental flow area shapes used in this paper are either rectangular or triangular. The forms of the flow area structure, made up of an assembly of optimized elemental flow areas to obtain bigger flow areas, are rectangle-in-rectangle, rectangle-in-triangle, triangle-in-triangle and triangle-in-rectangle. The global maximum revenue, revenue collected per unit flow area and the shape and sizes of each flow area structure have been derived in optimized conditions. The results for each flow area structure have been compared with the results of the other structures to determine the structure that provides better performance. The conclusion is that the rectangle-in-triangle flow area structure

  7. Cholera in Azov area

    Directory of Open Access Journals (Sweden)

    O. N. Domashenko

    2015-01-01

    Full Text Available The purpose of research is analysis of clinical course and treatment results of patients with cholera in the Azov area. Materials and methods. During the period from 29.05.2011 to 19.08.2011 33 cases of cholera (32 adults and 1 child and 25 vibrio carriers (22 adults and 3 children, which were caused by toxigenic strains of Vibrio cholera El Tor serogroup O1 Ogawa. Results. Likely factors of disease transmission in Mariupol are sea and river water, and the fish that were caught in the waters of the city. Typical and watery diarrhoea, vomiting, abdominal pain and lack of normal body temperature, dehydration syndrome, characterized clinical cholera for adults in most cases. The mean duration of diarrhoea was 6,6 days. At 46.9% observed atypical symptoms in 10 (31,3% – abdominal pain (1 patient cramping in 7 cases, localized in the epigastria region, at 2-over stomach. In 5 patients (15,6% had an increase in body temperature to 37,2–37,7 degrees Celsius. In 15 (46,9% patients had severe nausea accompanied by vomiting. Easy for cholera was observed in 1 (3.1%, moderate – in 14 (43,8%, heavy – in 17 (53,1% patients. Dehydration I level is set at 4 (12,5%, II – from 6 (18,7%, III – in 18 (56,3%, IV – 4 (12,5% patients. Cholera outbreak was characterized by a predominance of severe disease and severe dehydration (III and IV, which was observed in 68.8% of patients. The decisive factor in the treatment of cholera patients was initiated in a timely manner rehydration therapy, in particular the introduction of the solution «Trisol». Against the background of rehydration therapy hyperkalaemia was observed in 9,4% of cases, vascular rehydration at 9,4%, the cell rehydration in 3,1% of patients. Fatal accidents cholera outbreaks have not been observed. Conclusion. Clinical diagnosis of cholera and the provision of medical care in the prehospital phase were poor, indicating the need for systematic conducting training seminars among experts

  8. 5 CFR 591.207 - Which areas are COLA areas?

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Which areas are COLA areas? 591.207 Section 591.207 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ALLOWANCES AND DIFFERENTIALS Cost-of-Living Allowance and Post Differential-Nonforeign Areas Cost-Of-Living...

  9. Living in Prone Flooding Area: in Coastal Areas of Semarang

    Science.gov (United States)

    Tyas, W. P.

    2018-02-01

    When settlements are not able to provide a comfort area to live in, in this case because of a periodic threat of tidal flood coming to certain settlement areas, it is likely that the people still cannot leave the area. This paper explores the leading factors of the attachment of people to the areas, from economic, physical, social and psychological factors, including a place attachment. Therefore, the approach of the problem solution to tackle the tidal flooding in the areas should be also concern and have considerations relate to the factors.

  10. Area monitoring intelligent system - SIMA

    International Nuclear Information System (INIS)

    Bhoem, P.; Hisas, F.; Gelardi, G.

    1990-01-01

    The area monitoring intelligent system (SIMA) is an equipment to be used in radioprotection. SIMA has the function of monitoring the radiation levels of determined areas of the installations where radioactive materials are handled. (Author) [es

  11. Catch-In-Areas Main

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Catch-In-Areas database integrates catch data from the Catch Accounting System (which has the spatial resolution of a NMFS Reporting Area) into a database that...

  12. World Area Forecast System (WAFS)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The World Area Forecast System (WAFS) is a worldwide system by which world area forecast centers provide aeronautical meteorological en-route forecasts in uniform...

  13. LIHTC Difficult to Develop Areas

    Data.gov (United States)

    Department of Housing and Urban Development — A Difficult Development Area (DDA) for the Low Income Housing Tax Credit program is an area designated by the U.S. Department of Housing and Urban Development (HUD)...

  14. NORTH END ROADLESS AREA, ARIZONA.

    Science.gov (United States)

    Drewes, Harald; Bigsby, P.R.

    1984-01-01

    Studies conducted in the North End Roadless Area, Arizona indicate probable or substantiated metallic mineral-resource potential in about one-fifth of the area. The area has potential for disseminated or stockwork-type molybdenum mineralization, copper-lead-zinc-silver veins, lead-zinc-silver limestone replacement deposits, and tungsten-bearing contact metamorphic skarn deposits. The area also contains cement rock and marble dimension stone, but has only slight promise for the occurrence of petroleum and natural gas.

  15. Evaluating a County-Sponsored Social Marketing Campaign to Increase Mothers' Initiation of HPV Vaccine for their Pre-teen Daughters in a Primarily Rural Area.

    Science.gov (United States)

    Cates, Joan R; Shafer, Autumn; Diehl, Sandra J; Deal, Allison M

    2011-01-01

    Routine vaccination against human papillomavirus (HPV), the main cause of cervical cancer, is recommended for 11-12 year old girls, yet vaccine uptake is low. This study evaluates a social marketing campaign initiated by 13 North Carolina counties to raise awareness among parents and reduce barriers to accessing the vaccine in a primarily rural area. The 3-month campaign targeted mothers of girls ages 11-12 and healthcare practices serving pre-teen girls in four counties. Principles of social marketing were: product (recommended vaccine against HPV), price (cost, perception of safety and efficacy, and access), promotion (posters, brochures, website, news releases, doctor's recommendation), and place (doctors' offices, retail outlets). We analyzed (1) website traffic, hotline calls, and media placement; (2) cross-sectional surveys of mothers and providers; and (3) HPV immunization rates in intervention versus non-intervention counties. Of respondent mothers (n=225), 82% heard or saw campaign messages or materials. Of respondent providers (n=35), 94% used campaign brochures regularly or occasionally in conversations with parents. HPV vaccination rates within six months of campaign launch were 2% higher for 9-13 year old girls in two of the four intervention counties compared to 96 non-intervention counties. This evaluation supports campaign use in other primarily rural and underserved areas.

  16. Evaluating a County-Sponsored Social Marketing Campaign to Increase Mothers’ Initiation of HPV Vaccine for their Pre-teen Daughters in a Primarily Rural Area

    Science.gov (United States)

    Cates, Joan R.; Shafer, Autumn; Diehl, Sandra J.; Deal, Allison M.

    2011-01-01

    Routine vaccination against human papillomavirus (HPV), the main cause of cervical cancer, is recommended for 11–12 year old girls, yet vaccine uptake is low. This study evaluates a social marketing campaign initiated by 13 North Carolina counties to raise awareness among parents and reduce barriers to accessing the vaccine in a primarily rural area. The 3-month campaign targeted mothers of girls ages 11–12 and healthcare practices serving pre-teen girls in four counties. Principles of social marketing were: product (recommended vaccine against HPV), price (cost, perception of safety and efficacy, and access), promotion (posters, brochures, website, news releases, doctor’s recommendation), and place (doctors’ offices, retail outlets). We analyzed (1) website traffic, hotline calls, and media placement; (2) cross-sectional surveys of mothers and providers; and (3) HPV immunization rates in intervention versus non-intervention counties. Of respondent mothers (n=225), 82% heard or saw campaign messages or materials. Of respondent providers (n=35), 94% used campaign brochures regularly or occasionally in conversations with parents. HPV vaccination rates within six months of campaign launch were 2% higher for 9–13 year old girls in two of the four intervention counties compared to 96 non-intervention counties. This evaluation supports campaign use in other primarily rural and underserved areas. PMID:21804767

  17. PIEDRA WILDERNESS STUDY AREA, COLORADO.

    Science.gov (United States)

    Condon, Steven M.; Brown, S. Don

    1984-01-01

    The Pedra Wilderness Study Area, located approximately 30 mi northeast of Durango, Colorado, was evaluated for its mineral-resource potential. Geochemical and geophysical studies indicate little promise for the occurrence of mineral or energy resources in this area. This conclusion is supported by the findings of the earlier study and is suggested by the absence of significant mining activity in the area.

  18. Catchment areas for public transport

    DEFF Research Database (Denmark)

    Andersen, Jonas Lohmann Elkjær; Landex, Alex

    2008-01-01

    In the planning of public transport catchment areas of stops are often included to estimate potential number of travellers. There are different approaches to GIS-based catchment area analyses depending on the desired level of detail. The Circular Buffer approach is the fundamental, but also....../from stations. The article also shows how the refinement of the Service Area approach with additional time resistance results in smaller catchment areas when the feeder routes cross stairs. It is concluded that GIS-based catchment area analyses are a multiple decision support tool for planning of public...... transport where the level of detail can be suited to the purpose....

  19. MPLS for metropolitan area networks

    CERN Document Server

    Tan, Nam-Kee

    2004-01-01

    METROPOLITAN AREA NETWORKS AND MPLSRequirements of Metropolitan Area Network ServicesMetropolitan Area Network OverviewThe Bandwidth DemandThe Metro Service Provider's Business ApproachesThe Emerging Metro Customer Expectations and NeedsSome Prevailing Metro Service OpportunitiesService Aspects and RequirementsRoles of MPLS in Metropolitan Area NetworksMPLS PrimerMPLS ApplicationsTRAFFIC ENGINEERING ASPECTS OF METROPOLITAN AREA NETWORKSTraffic Engineering ConceptsNetwork CongestionHyper Aggregation ProblemEasing CongestionNetwork ControlTactical versus Strategic Traffic EngineeringIP/ATM Overl

  20. Dual Orlicz geominimal surface area

    Directory of Open Access Journals (Sweden)

    Tongyi Ma

    2016-02-01

    Full Text Available Abstract The L p $L_{p}$ -geominimal surface area was introduced by Lutwak in 1996, which extended the important concept of the geominimal surface area. Recently, Wang and Qi defined the p-dual geominimal surface area, which belongs to the dual Brunn-Minkowski theory. In this paper, based on the concept of the dual Orlicz mixed volume, we extend the dual geominimal surface area to the Orlicz version and give its properties. In addition, the isoperimetric inequality, a Blaschke-Santaló type inequality, and the monotonicity inequality for the dual Orlicz geominimal surface areas are established.

  1. Council On Library Resources, Inc. Seventeenth Annual Report, For the Year Ending June 30, 1973.

    Science.gov (United States)

    Council on Library Resources, Inc., Washington, DC.

    This report describes the efforts of the Council on Library Resources to enhance the effectiveness, efficiency, and economy of operations in libraries during 1972-73. It covers 9 major areas: national library services, automation and networks, the academic library, the public library, microform and nonprint media, preservation and library…

  2. Fire Hazards Analysis for the 200 Area Interim Storage Area

    International Nuclear Information System (INIS)

    JOHNSON, D.M.

    2000-01-01

    This documents the Fire Hazards Analysis (FHA) for the 200 Area Interim Storage Area. The Interim Storage Cask, Rad-Vault, and NAC-1 Cask are analyzed for fire hazards and the 200 Area Interim Storage Area is assessed according to HNF-PRO-350 and the objectives of DOE Order 5480 7A. This FHA addresses the potential fire hazards associated with the Interim Storage Area (ISA) facility in accordance with the requirements of DOE Order 5480 7A. It is intended to assess the risk from fire to ensure there are no undue fire hazards to site personnel and the public and to ensure property damage potential from fire is within acceptable limits. This FHA will be in the form of a graded approach commensurate with the complexity of the structure or area and the associated fire hazards

  3. Protected area gap analysis of important bird areas in Tanzania

    DEFF Research Database (Denmark)

    Sritharan, Shakthi; Burgess, Neil David

    2012-01-01

    Analyses of gaps in protected area (PA) coverage of species distributions have been carried out extensively for the past two decades, aiming to better locate new PAs and conserve species. In this study, progress to close gaps in the protection of the Important Bird Areas (IBAs) of Tanzania...

  4. Planning approaches for rurban areas

    DEFF Research Database (Denmark)

    Busck, Anne Gravsholt; Hidding, Marjan; Kristensen, Søren Bech Pilgaard

    2009-01-01

    ), Staffanstorp municipality (Sweden) and Werv-area (the Netherlands). All three areas belong to the rurban zone and are selected to exemplify pro-active planning. The analysis focuses on how the concept of compact city is perceived and implemented, how rurban areas are managed in order to avoid further urban...... encroachment, and how resilient green landscapes are ensured. The results reveal significant differences in approaches, reflecting variations in the public involvement in rurban areas development, the role of different administrative levels and the use of zonation. Variation in the use of zonation encapsulates...

  5. BENTON RANGE ROADLESS AREA, CALIFORNIA.

    Science.gov (United States)

    McKee, Edwin H.; Rains, Richard L.

    1984-01-01

    On the basis of a mineral survey, two parts of the Benton Range Roadless Area, California are considered to have mineral-resource potential. The central and southern part of the roadless area, near several nonoperating mines, has a probable potential for tungsten and gold-silver mineralization in tactite zones. The central part of the area has a substantiated resource potential for gold and silver in quartz veins. Detailed mapping and geochemical sampling for tungsten, gold, and silver in the central and southern part of the roadless area might indicate targets for shallow drilling exploration.

  6. Small Engine & Accessory Test Area

    Data.gov (United States)

    Federal Laboratory Consortium — The Small Engine and Accessories Test Area (SEATA) facilitates testaircraft starting and auxiliary power systems, small engines and accessories. The SEATA consists...

  7. Runoff estimation in residencial area

    Directory of Open Access Journals (Sweden)

    Meire Regina de Almeida Siqueira

    2013-12-01

    Full Text Available This study aimed to estimate the watershed runoff caused by extreme events that often result in the flooding of urban areas. The runoff of a residential area in the city of Guaratinguetá, São Paulo, Brazil was estimated using the Curve-Number method proposed by USDA-NRCS. The study also investigated current land use and land cover conditions, impermeable areas with pasture and indications of the reforestation of those areas. Maps and satellite images of Residential Riverside I Neighborhood were used to characterize the area. In addition to characterizing land use and land cover, the definition of the soil type infiltration capacity, the maximum local rainfall, and the type and quality of the drainage system were also investigated. The study showed that this neighborhood, developed in 1974, has an area of 792,700 m², a population of 1361 inhabitants, and a sloping area covered with degraded pasture (Guaratinguetá-Piagui Peak located in front of the residential area. The residential area is located in a flat area near the Paraiba do Sul River, and has a poor drainage system with concrete pipes, mostly 0.60 m in diameter, with several openings that capture water and sediments from the adjacent sloping area. The Low Impact Development (LID system appears to be a viable solution for this neighborhood drainage system. It can be concluded that the drainage system of the Guaratinguetá Riverside I Neighborhood has all of the conditions and characteristics that make it suitable for the implementation of a low impact urban drainage system. Reforestation of Guaratinguetá-Piagui Peak can reduce the basin’s runoff by 50% and minimize flooding problems in the Beira Rio neighborhood.

  8. Tech Area II: A history

    Energy Technology Data Exchange (ETDEWEB)

    Ullrich, R. [Ktech Corp., Albuquerque, NM (United States)

    1998-07-01

    This report documents the history of the major buildings in Sandia National Laboratories` Technical Area II. It was prepared in support of the Department of Energy`s compliance with Section 106 of the National Historic Preservation Act. Technical Area II was designed and constructed in 1948 specifically for the final assembly of the non-nuclear components of nuclear weapons, and was the primary site conducting such assembly until 1952. Both the architecture and location of the oldest buildings in the area reflect their original purpose. Assembly activities continued in Area II from 1952 to 1957, but the major responsibility for this work shifted to other sites in the Atomic Energy Commission`s integrated contractor complex. Gradually, additional buildings were constructed and the original buildings were modified. After 1960, the Area`s primary purpose was the research and testing of high-explosive components for nuclear weapons. In 1994, Sandia constructed new facilities for work on high-explosive components outside of the original Area II diamond-shaped parcel. Most of the buildings in the area are vacant and Sandia has no plans to use them. They are proposed for decontamination and demolition as funding becomes available.

  9. The Histogram-Area Connection

    Science.gov (United States)

    Gratzer, William; Carpenter, James E.

    2008-01-01

    This article demonstrates an alternative approach to the construction of histograms--one based on the notion of using area to represent relative density in intervals of unequal length. The resulting histograms illustrate the connection between the area of the rectangles associated with particular outcomes and the relative frequency (probability)…

  10. USE OF THE PICNIC AREA

    CERN Multimedia

    Relations with the Host States Service

    2001-01-01

    On the Prévessin site CERN has provided a picnic area which is available for use by persons working on its site subject to prior reservation. The person in charge of this picnic area is Mr Yves CHEVRET ST/TFM. Following a fresh outbreak of incidents (damage to CERN equipment and to trees and plants, privately owned sheep killed or maimed by dogs belonging to users of the picnic area, etc.),   The following measures have been taken: a report on the state of the picnic area will be drawn up before and after use, the cost of any damage noted will be borne by the person making the reservation, dogs and other domestic animals are strictly forbidden in the picnic area.

  11. Water Service Areas - MDC_WaterServiceArea

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — The Water and Sewer Service Area layer was derived from the original paper based sketches which contained both water and sewer utility boundary information. This...

  12. Sewerage Service Areas - MDC_SewerServiceArea

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — The Water and Sewer Service Area layer was derived from the original paper based sketches which contained both water and sewer utility boundary information. This...

  13.   Transformation of the industrial harbor areas to housing areas

    DEFF Research Database (Denmark)

    Rehder, Meike

    2009-01-01

    Research question: How to read the universal (understood as the common and the social) and the individual (understood as the specific, private and intimate) in the meeting between urban and housing space? Questions in the project: How do the exterior spaces in these new harbour areas come to being......? What influences are at play in the development of them? What influences the approval and the functioning of these housing areas?...

  14. Selection of material balance areas and item control areas

    International Nuclear Information System (INIS)

    1975-04-01

    Section 70.58, ''Fundamental Nuclear Material Controls,'' of 10 CFR Part 70, ''Special Nuclear Material,'' requires certain licensees authorized to possess more than one effective kilogram of special nuclear material to establish Material Balance Areas (MBAs) or Item Control Areas (ICAs) for the physical and administrative control of nuclear materials. This section requires that: (1) each MBA be an identifiable physical area such that the quantity of nuclear material being moved into or out of the MBA is represented by a measured value; (2) the number of MBAs be sufficient to localize nuclear material losses or thefts and identify the mechanisms; (3) the custody of all nuclear material within an MBA or ICA be the responsibility of a single designated individual; and (4) ICAs be established according to the same criteria as MBAs except that control into and out of such areas would be by item identity and count for previously determined special nuclear material quantities, the validity of which must be ensured by tamper-safing unless the items are sealed sources. This guide describes bases acceptable to the NRC staff for the selection of material balance areas and item control areas. (U.S.)

  15. Hanford 200 Areas Development Plan

    Energy Technology Data Exchange (ETDEWEB)

    Rinne, C.A.; Daly, K.S.

    1993-08-01

    The purpose of the Hanford 200 Areas Development Plan (Development Plan) is to guide the physical development of the 200 Areas (which refers to the 200 East Area, 200 West Area, and 200 Area Corridor, located between the 200 East and 200 West Areas) in accordance with US Department of Energy (DOE) Order 4320.lB (DOE 1991a) by performing the following: Establishing a land-use plan and setting land-use categories that meet the needs of existing and proposed activities. Coordinating existing, 5-year, and long-range development plans and guiding growth in accordance with those plans. Establishing development guidelines to encourage cost-effective development and minimize conflicts between adjacent activities. Identifying site development issues that need further analysis. Integrating program plans with development plans to ensure a logical progression of development. Coordinate DOE plans with other agencies [(i.e., Washington State Department of Ecology (Ecology) and US Environmental Protection Agency (EPA)]. Being a support document to the Hanford Site Development Plan (DOE-RL 1990a) (parent document) and providing technical site information relative to the 200 Areas.

  16. Hanford 200 Areas Development Plan

    International Nuclear Information System (INIS)

    Rinne, C.A.; Daly, K.S.

    1993-08-01

    The purpose of the Hanford 200 Areas Development Plan (Development Plan) is to guide the physical development of the 200 Areas (which refers to the 200 East Area, 200 West Area, and 200 Area Corridor, located between the 200 East and 200 West Areas) in accordance with US Department of Energy (DOE) Order 4320.lB (DOE 1991a) by performing the following: Establishing a land-use plan and setting land-use categories that meet the needs of existing and proposed activities. Coordinating existing, 5-year, and long-range development plans and guiding growth in accordance with those plans. Establishing development guidelines to encourage cost-effective development and minimize conflicts between adjacent activities. Identifying site development issues that need further analysis. Integrating program plans with development plans to ensure a logical progression of development. Coordinate DOE plans with other agencies [(i.e., Washington State Department of Ecology (Ecology) and US Environmental Protection Agency (EPA)]. Being a support document to the Hanford Site Development Plan (DOE-RL 1990a) (parent document) and providing technical site information relative to the 200 Areas

  17. Analysis of context factors in compulsory and incentive strategies for improving attraction and retention of health workers in rural and remote areas: a systematic review.

    Science.gov (United States)

    Liu, Xiaoyun; Dou, Lixia; Zhang, Huan; Sun, Yang; Yuan, Beibei

    2015-07-21

    Current literature systematically reports that interventions to attract and retain health workers in underserved areas need to be context specific but rarely defines what that means. In this systematic review, we try to summarize and analyse context factors influencing the implementation of interventions to attract and retain rural health workers. We searched online databases, relevant websites and reference lists of selected literature to identify studies on compulsory rural service programmes and financial incentives. Forty studies were selected. Information regarding context factors at macro, meso and micro levels was extracted and synthesized. Macro-level context factors include political, economic and social factors. Meso-level factors include health system factors such as maldistribution of health workers, growing private sector, decentralization and health financing. Micro-level factors refer to the policy implementation process including funding sources, administrative agency, legislation process, monitoring and evaluation. Macro-, meso- and micro-level context factors can play different roles in agenda setting, policy formulation and implementation of health interventions to attract and retain rural health workers. These factors should be systematically considered in the different stages of policy process and evaluation.

  18. Android Based Area Web Monitoring

    Science.gov (United States)

    Kanigoro, Bayu; Galih Salman, Afan; Moniaga, Jurike V.; Chandra, Eric; Rezky Chandra, Zein

    2014-03-01

    The research objective is to develop an application that can be used in the monitoring of an area by using a webcam. It aims to create a sense of security on the user's application because it can monitor an area using mobile phone anywhere. The results obtained in this study is to create an area with a webcam monitoring application that can be accessed anywhere as long as the monitoring results have internet access and can also be accessed through Android Based Mobile Phone.

  19. Android Based Area Web Monitoring

    Directory of Open Access Journals (Sweden)

    Kanigoro Bayu

    2014-03-01

    Full Text Available The research objective is to develop an application that can be used in the monitoring of an area by using a webcam. It aims to create a sense of security on the user's application because it can monitor an area using mobile phone anywhere. The results obtained in this study is to create an area with a webcam monitoring application that can be accessed anywhere as long as the monitoring results have internet access and can also be accessed through Android Based Mobile Phone.

  20. AN EXAMPLE IN SURFACE AREA*

    Science.gov (United States)

    Goffman, Casper

    1969-01-01

    For length and area, a central fact is that the value of the length of a curve or the area of a surface, as given by the Lebesgue theory, is at least as great as that given by the classical formula, whenever the latter has meaning. This is now found not to be valid in higher dimensions. We give an example of a continuous mapping of the unit cube into itself for which the value given by the formula exceeds the three-dimensional Lebesgue area of the corresponding suface. PMID:16591750

  1. Revitalization Areas By Block Group

    Data.gov (United States)

    Department of Housing and Urban Development — Single Family Revitalization areas are HUD-designated neighborhoods in need of economic and community development and where there is already a strong commitment by...

  2. Flood Hazard Areas - High Risk

    Data.gov (United States)

    Department of Homeland Security — The S_Fld_Haz_Ar table contains information about the flood hazards within the study area. A spatial file with locational information also corresponds with this data...

  3. Allegheny County Soil Type Areas

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains soil type and soil classification, by area. Additional info at: http://mcdc.cas.psu.edu/datawiz.htm;...

  4. Technical standards in nuclear area

    International Nuclear Information System (INIS)

    Grimberg, M.

    1978-01-01

    The technical standardization in nuclear area is discussed. Also, the competence of CNEN in standardization pursuit is analysed. Moreover, the process of working up of technical standards is explained; in addition, some kinds of technical standards are discussed. (author) [pt

  5. FEMA DFIRM Flood Hazard Areas

    Data.gov (United States)

    Minnesota Department of Natural Resources — FEMA flood hazard delineations are used by the Federal Emergency Management Agency (FEMA) to designate the Special Flood Hazard Area (SFHA) and for insurance rating...

  6. Local Area Networks (The Printout).

    Science.gov (United States)

    Aron, Helen; Balajthy, Ernest

    1989-01-01

    Describes the Local Area Network (LAN), a project in which students used LAN-based word processing and electronic mail software as the center of a writing process approach. Discusses the advantages and disadvantages of networking. (MM)

  7. Allegheny County Land Cover Areas

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Land Cover dataset demarcates 14 land cover types by area; such as Residential, Commercial, Industrial, Forest, Agriculture, etc. If viewing this description on...

  8. Biodiversity mapping in sensitive areas

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, Tor; Ulssnes, Amund; Nissen-Lie, Torild [DNV, Oslo (Norway)

    2008-07-01

    When oil companies are entering new unexplored areas their potential footprint on the environment should be measured in a way that necessary action could be included in the planning of the activity. These actions should reduce the impact to accepted levels. Traditional baseline studies, including sediment and macro fauna sampling, are carried out in homogeneous areas. In heterogeneous and unexplored areas there is a need for more information than these traditional sediment analyses can give. To increase the knowledge from specific areas biodiversity mapping has been carried out. To combine the knowledge from ROV surveys, modelling, current measurements, sediment characteristics, seismic, macro fauna and background levels of chemicals contents in the sediments, both prior to the exploration, and after the drilling have taken place the operator can document their footprint on the marine environment. (author)

  9. Allegheny County Land Use Areas

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Allegheny County land use as ascribed to areas of land. The Land Use Feature Dataset contains photogrammetrically compiled information concerning vegetation and...

  10. Ozone Nonattainment Areas - 1 Hour

    Data.gov (United States)

    U.S. Environmental Protection Agency — This data layer identifies areas in the U.S. where air pollution levels have not met the National Ambient Air Quality Standards (NAAQS) for Ozone - 1hour (Legacy...

  11. Allegheny County Environmental Justice Areas

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Environmental Justice areas in this guide have been defined by the Pennsylvania Department of Environmental Protection. The Department defines an environmental...

  12. Allegheny County Wooded Area Boundaries

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset demarcates stands of trees (coniferous and deciduous) too numerous to plot as individual trees. The area is delineated following a generalized line...

  13. Upper limit of peak area

    International Nuclear Information System (INIS)

    Helene, O.A.M.

    1982-08-01

    The determination of the upper limit of peak area in a multi-channel spectra, with a known significance level is discussed. This problem is specially important when the peak area is masked by the background statistical fluctuations. The problem is exactly solved and, thus, the results are valid in experiments with small number of events. The results are submitted to a Monte Carlo test and applied to the 92 Nb beta decay. (Author) [pt

  14. SPANISH PEAKS PRIMITIVE AREA, MONTANA.

    Science.gov (United States)

    Calkins, James A.; Pattee, Eldon C.

    1984-01-01

    A mineral survey of the Spanish Peaks Primitive Area, Montana, disclosed a small low-grade deposit of demonstrated chromite and asbestos resources. The chances for discovery of additional chrome resources are uncertain and the area has little promise for the occurrence of other mineral or energy resources. A reevaluation, sampling at depth, and testing for possible extensions of the Table Mountain asbestos and chromium deposit should be undertaken in the light of recent interpretations regarding its geologic setting.

  15. Sprawl in European urban areas

    Science.gov (United States)

    Prastacos, Poulicos; Lagarias, Apostolos

    2016-08-01

    In this paper the 2006 edition of the Urban Atlas database is used to tabulate areas of low development density, usually referred to as "sprawl", for many European cities. The Urban Atlas database contains information on the land use distribution in the 305 largest European cities. Twenty different land use types are recognized, with six of them representing urban fabric. Urban fabric classes are residential areas differentiated by the density of development, which is measured by the sealing degree parameter that ranges from 0% to 100% (non-developed, fully developed). Analysis is performed on the distribution of the middle to low density areas defined as those with sealing degree less than 50%. Seven different country groups in which urban areas have similar sprawl characteristics are identified and some key characteristics of sprawl are discussed. Population of an urban area is another parameter considered in the analysis. Two spatial metrics, average patch size and mean distance to the nearest neighboring patch of the same class, are used to describe proximity/separation characteristics of sprawl in the urban areas of the seven groups.

  16. Arcjet nozzle area ratio effects

    Science.gov (United States)

    Curran, Francis M.; Sarmiento, Charles J.; Birkner, Bjorn W.; Kwasny, James

    1990-01-01

    An experimental investigation was conducted to determine the effect of nozzle area ratio on the operating characteristics and performance of a low power dc arcjet thruster. Conical thoriated tungsten nozzle inserts were tested in a modular laboratory arcjet thruster run on hydrogen/nitrogen mixtures simulating the decomposition products of hydrazine. The converging and diverging sides of the inserts had half angles of 30 and 20 degrees, respectively, similar to a flight type unit currently under development. The length of the diverging side was varied to change the area ratio. The nozzle inserts were run over a wide range of specific power. Current, voltage, mass flow rate, and thrust were monitored to provide accurate comparisons between tests. While small differences in performance were observed between the two nozzle inserts, it was determined that for each nozzle insert, arcjet performance improved with increasing nozzle area ratio to the highest area ratio tested and that the losses become very pronounced for area ratios below 50. These trends are somewhat different than those obtained in previous experimental and analytical studies of low Re number nozzles. It appears that arcjet performance can be enhanced via area ratio optimization.

  17. Arcjet Nozzle Area Ratio Effects

    Science.gov (United States)

    Curran, Francis M.; Sarmiento, Charles J.; Birkner, Bjorn W.; Kwasny, James

    1990-01-01

    An experimental investigation was conducted to determine the effect of nozzle area ratio on the operating characteristics and performance of a low power dc arcjet thruster. Conical thoriated tungsten nozzle inserts were tested in a modular laboratory arcjet thruster run on hydrogen/nitrogen mixtures simulating the decomposition products of hydrazine. The converging and diverging sides of the inserts had half angles of 30 and 20 degrees, respectively, similar to a flight type unit currently under development. The length of the diverging side was varied to change the area ratio. The nozzle inserts were run over a wide range of specific power. Current, voltage, mass flow rate, and thrust were monitored to provide accurate comparisons between tests. While small differences in performance were observed between the two nozzle inserts, it was determined that for each nozzle insert, arcjet performance improved with increasing nozzle area ratio to the highest area ratio tested and that the losses become very pronounced for area ratios below 50. These trends are somewhat different than those obtained in previous experimental and analytical studies of low Re number nozzles. It appears that arcjet performance can be enhanced via area ratio optimization.

  18. Area-to-Area Poisson Kriging and Spatial Bayesian Analysis

    Science.gov (United States)

    Asmarian, Naeimehossadat; Jafari-Koshki, Tohid; Soleimani, Ali; Taghi Ayatollahi, Seyyed Mohammad

    2016-10-01

    Background: In many countries gastric cancer has the highest incidence among the gastrointestinal cancers and is the second most common cancer in Iran. The aim of this study was to identify and map high risk gastric cancer regions at the county-level in Iran. Methods: In this study we analyzed gastric cancer data for Iran in the years 2003-2010. Areato- area Poisson kriging and Besag, York and Mollie (BYM) spatial models were applied to smoothing the standardized incidence ratios of gastric cancer for the 373 counties surveyed in this study. The two methods were compared in term of accuracy and precision in identifying high risk regions. Result: The highest smoothed standardized incidence rate (SIR) according to area-to-area Poisson kriging was in Meshkinshahr county in Ardabil province in north-western Iran (2.4,SD=0.05), while the highest smoothed standardized incidence rate (SIR) according to the BYM model was in Ardabil, the capital of that province (2.9,SD=0.09). Conclusion: Both methods of mapping, ATA Poisson kriging and BYM, showed the gastric cancer incidence rate to be highest in north and north-west Iran. However, area-to-area Poisson kriging was more precise than the BYM model and required less smoothing. According to the results obtained, preventive measures and treatment programs should be focused on particular counties of Iran. Creative Commons Attribution License

  19. Sapwood area - leaf area relationships for coast redwood

    OpenAIRE

    Stancioiu, P T; O'Hara, K L

    2005-01-01

    Coast redwood (Sequoia sempervirens (D. Don) Endl.) trees in different canopy strata and crown positions were sampled to develop relationships between sapwood cross-sectional area and projected leaf area. Sampling occurred during the summers of 2000 and 2001 and covered tree heights ranging from 7.7 to 45.2 m and diameters at breast height ranging from 9.4 to 92.7 cm. Foliage morphology varied greatly and was stratified into five types based on needle type (sun or shade) and twig color. A str...

  20. Notes on the area theorem

    International Nuclear Information System (INIS)

    Park, Mu-In

    2008-01-01

    Hawking's area theorem can be understood from a quasi-stationary process in which a black hole accretes positive energy matter, independent of the details of the gravity action. I use this process to study the dynamics of the inner as well as the outer horizons for various black holes which include the recently discovered exotic black holes and three-dimensional black holes in higher derivative gravities as well as the usual BTZ black hole and the Kerr black hole in four dimensions. I find that the area for the inner horizon 'can decrease', rather than increase, with the quasi-stationary process. However, I find that the area for the outer horizon 'never decreases' such that the usual area theorem still works in our examples, though this is quite non-trivial in general. There exists an instability problem of the inner horizons but it seems that the instability is not important in my analysis. I also find a generalized area theorem by combining those of the outer and inner horizons

  1. Heat Pumps in Subarctic Areas

    DEFF Research Database (Denmark)

    Atlason, Reynir Smari; Oddsson, Gudmundur Valur; Unnthorsson, Runar

    2017-01-01

    Geothermal heat pumps use the temperature difference between inside and outside areas to modify a refrigerant, either for heating or cooling. Doing so can lower the need for external heating energy for a household to some extent. The eventual impact depends on various factors, such as the external...... source for heating or cooling and the temperature difference. The use of geothermal heat pumps, and eventual benefits has not been studied in the context of frigid areas, such as in Iceland. In Iceland, only remote areas do not have access to district heating from geothermal energy where households may...... therefor benefit from using geothermal heat pumps. It is the intent of this study to explore the observed benefits of using geothermal heat pumps in Iceland, both financially and energetically. This study further elaborates on incentives provided by the Icelandic government. Real data was gathered from...

  2. Multifunctional centers in rural areas

    DEFF Research Database (Denmark)

    Svendsen, Gunnar Lind Haase

    2009-01-01

    abandoned. One outcome has been closings of schools in remote rural areas. This evidently contributes to exacerbate depopulation in these areas. To stop this tendency, we need new models for high-quality, cost effective public services in rural areas as those as we find in Denmark. This chapter introduces...... ideological roots in history pointing at 19th c. national civic movements and an early 20th c. transnational Garden City movement within urban planning as crucial. Drawing on contemporary case studies of multifunctional centers in Holland and Denmark, I then suggest that public and private donors should...... invest in multifunctional centers in which the local public school is the dynamo. This in order to increase local levels of social as well as human capital. Ideally, such centers should contain both public services such as school, library and health care, private enterprises as hairdressers and banks...

  3. 100 Areas CERCLA ecological investigations

    Energy Technology Data Exchange (ETDEWEB)

    Landeen, D.S.; Sackschewsky, M.R.; Weiss, S.

    1993-09-01

    This document reports the results of the field terrestrial ecological investigations conducted by Westinghouse Hanford Company during fiscal years 1991 and 1992 at operable units 100-FR-3, 100-HR-3, 100-NR-2, 100-KR-4, and 100-BC-5. The tasks reported here are part of the Remedial Investigations conducted in support of the Comprehensive Environmental Response, compensation, and Liability Act of 1980 studies for the 100 Areas. These ecological investigations provide (1) a description of the flora and fauna associated with the 100 Areas operable units, emphasizing potential pathways for contaminants and species that have been given special status under existing state and/or federal laws, and (2) an evaluation of existing concentrations of heavy metals and radionuclides in biota associated with the 100 Areas operable units.

  4. 100 Areas CERCLA ecological investigations

    International Nuclear Information System (INIS)

    Landeen, D.S.; Sackschewsky, M.R.; Weiss, S.

    1993-09-01

    This document reports the results of the field terrestrial ecological investigations conducted by Westinghouse Hanford Company during fiscal years 1991 and 1992 at operable units 100-FR-3, 100-HR-3, 100-NR-2, 100-KR-4, and 100-BC-5. The tasks reported here are part of the Remedial Investigations conducted in support of the Comprehensive Environmental Response, compensation, and Liability Act of 1980 studies for the 100 Areas. These ecological investigations provide (1) a description of the flora and fauna associated with the 100 Areas operable units, emphasizing potential pathways for contaminants and species that have been given special status under existing state and/or federal laws, and (2) an evaluation of existing concentrations of heavy metals and radionuclides in biota associated with the 100 Areas operable units

  5. Plutonium focus area: Technology summary

    International Nuclear Information System (INIS)

    1996-03-01

    To ensure research and development programs focus on the most pressing environmental restoration and waste management problems at the U.S. Department of Energy (DOE), the Assistant Secretary for the Office of Environmental Management (EM) established a working group in August 1993 to implement a new approach to research and technology development. As part of this approach, EM developed a management structure and principles that led to creation of specific focus areas. These organizations were designed to focus scientific and technical talent throughout DOE and the national scientific community on major environmental restoration and waste management problems facing DOE. The focus area approach provides the framework for inter-site cooperation and leveraging of resources on common problems. After the original establishment of five major focus areas within the Office of Technology Development (EM-50), the Nuclear Materials Stabilization Task Group (NMSTG, EM-66) followed EM-50's structure and chartered the Plutonium Focus Area (PFA). NMSTG's charter to the PFA, described in detail later in this book, plays a major role in meeting the EM-66 commitments to the Defense Nuclear Facilities Safety Board (DNFSB). The PFA is a new program for FY96 and as such, the primary focus of revision 0 of this Technology Summary is an introduction to the Focus Area; its history, development, and management structure, including summaries of selected technologies being developed. Revision 1 to the Plutonium Focus Area Technology Summary is slated to include details on all technologies being developed, and is currently planned for release in August 1996. The following report outlines the scope and mission of the Office of Environmental Management, EM-60, and EM-66 organizations as related to the PFA organizational structure

  6. Bicycle traffic in urban areas

    Directory of Open Access Journals (Sweden)

    Anđelković Zorica

    2015-01-01

    Full Text Available Cycling is a term describing the use of bicycles, but also any mean of transport driven solely by human power. Development of bicycle traffic in urban areas involves construction of cycling infrastructure, adapting streets and other traffic infrastructure to a form suitable for cycling and other means of transport (individual motorized traffic, public transport, walking, ensuring the adequate budget and systematic planning and development of sustainable transport in cities. The paper presents basic settings and conditions as input elements to plan bicycle traffic in urban areas, as well as program- design conditions which lead the activities of planners and designers of urban roads in connection with cyclists.

  7. Sediment problems in urban areas

    Science.gov (United States)

    Guy, Harold P.

    1970-01-01

    A recognition of and solution to sediment problems in urban areas is necessary if society is to have an acceptable living environment. Soil erosion and sediment deposition in urban areas are as much an environmental blight as badly paved and littered streets, dilapidated buildings, billboard clutter, inept land use, and air, water, and noise pollution. In addition, sediment has many direct and indirect effects on streams that may be either part of or very remote from the urban environment. Sediment, for example, is widely recognized as a pollutant of streams and other water bodies.

  8. Semenic Mountains’ alpine skiing area

    Directory of Open Access Journals (Sweden)

    Petru BANIAȘ

    2017-03-01

    Full Text Available The present paper presents, after a short history of alpine skiing which describes apparition, necessity, utility and universality of skiing during time, a comparative study referring to the alpine skiing domain in the Semenic Mountains area. In the paper are also presented general notions about alpine skiing methodology together with an ample description of the plateau area form Semenic Mountains, describing localization and touristic potential. Based on the SWOT analysis made for each slope, was realized a complex analysis of the entire skiing domain, an analysis which includes technical, financial, climatic and environmental aspects, along with an analysis of the marketing policy applied for the specific zone.

  9. CACTUS SPRING ROADLESS AREA, CALIFORNIA.

    Science.gov (United States)

    Matti, Jonathan C.; Kuizon, Lucia

    1984-01-01

    Geologic, geochemical, and geophysical studies together with a review of historic mining and prospecting activities indicate that the Cactus Spring Roadless Area in California has little promise for the occurrence of mineral or energy resources. Marble bodies occur in the northern part of the roadless area and are possible resources for building stone, crushed and quarried aggregate, and lime and magnesium for Portland cement and industrial applications. It is recommended that the terrane of marble be mapped and sampled carefully in order to evaluate the quantity and quality of the carbonate resources.

  10. Determination of retinal surface area.

    Science.gov (United States)

    Nagra, Manbir; Gilmartin, Bernard; Thai, Ngoc Jade; Logan, Nicola S

    2017-09-01

    Previous attempts at determining retinal surface area and surface area of the whole eye have been based upon mathematical calculations derived from retinal photographs, schematic eyes and retinal biopsies of donor eyes. 3-dimensional (3-D) ocular magnetic resonance imaging (MRI) allows a more direct measurement, it can be used to image the eye in vivo, and there is no risk of tissue shrinkage. The primary purpose of this study is to compare, using T2-weighted 3D MRI, retinal surface areas for superior-temporal (ST), inferior-temporal (IT), superior-nasal (SN) and inferior-nasal (IN) retinal quadrants. An ancillary aim is to examine whether inter-quadrant variations in area are concordant with reported inter-quadrant patterns of susceptibility to retinal breaks associated with posterior vitreous detachment (PVD). Seventy-three adult participants presenting without retinal pathology (mean age 26.25 ± 6.06 years) were scanned using a Siemens 3-Tesla MRI scanner to provide T2-weighted MR images that demarcate fluid-filled internal structures for the whole eye and provide high-contrast delineation of the vitreous-retina interface. Integrated MRI software generated total internal ocular surface area (TSA). The second nodal point was used to demarcate the origin of the peripheral retina in order to calculate total retinal surface area (RSA) and quadrant retinal surface areas (QRSA) for ST, IT, SN, and IN quadrants. Mean spherical error (MSE) was -2.50 ± 4.03D and mean axial length (AL) 24.51 ± 1.57 mm. Mean TSA and RSA for the RE were 2058 ± 189 and 1363 ± 160 mm 2 , respectively. Repeated measures anova for QRSA data indicated a significant difference within-quadrants (P area/mm increase in AL. Although the differences between QRSAs are relatively small, there was evidence of concordance with reported inter-quadrant patterns of susceptibility to retinal breaks associated with PVD. The data allow AL to be converted to QRSAs, which will assist further

  11. Integrated Assessment of Coastal Areas

    Science.gov (United States)

    Nicholls, R. J.

    2016-12-01

    Coastal areas are experiencing change due to a range of natural and human-induced drivers. Of particular concern is climate change, particularly sea-level rise (SLR). In low gradient coastal areas, small changes in water levels can have profound consequences. Hence SLR is rightly considered a major threat. However, to properly diagnose a problem and find sustainable solutions, a systems approach is essential as the impacts of SLR will be modified by the other drivers. This paper will consider these issues from a multi-disciplinary perspective drawing on examples from around the world.

  12. AGUA TIBIA PRIMITIVE AREA, CALIFORNIA.

    Science.gov (United States)

    Irwin, William P.; Thurber, Horace K.

    1984-01-01

    The Agua Tibia Primitive Area in southwestern California is underlain by igneous and metamorphic rocks that are siilar to those widely exposed throughout much of the Peninsular Ranges. To detect the presence of any concealed mineral deposits, samples of stream sediments were collected along the various creeks that head in the mountain. As an additional aid in evaluating the mineral potential, an aeromagnetic survey was made and interpreted. A search for records of past or existing mining claims within the primitive area was made but none was found. Evidence of deposits of metallic or nonmetallic minerals was not seen during the study.

  13. Soil variability in mountain areas

    OpenAIRE

    Zanini, E.; Freppaz, M.; Stanchi, S.; Bonifacio, E.; Egli, M.

    2015-01-01

    The high spatial variability of soils is a relevant issue at local and global scales, and determines the complexity of soil ecosystem functions and services. This variability derives from strong dependencies of soil ecosystems on parent materials, climate, relief and biosphere, including human impact. Although present in all environments, the interactions of soils with these forming factors are particularly striking in mountain areas.

  14. Portable sandblaster cleans small areas

    Science.gov (United States)

    Severin, H. J.

    1966-01-01

    Portable sandblasting unit rapidly and effectively cleans localized areas on a metal surface. The unit incorporates a bellows enclosure, masking plate, sand container, and used sand accummulator connected to a vacuum system. The bellows is equipped with an inspection window and light for observation of the sanding operation.

  15. ARC Research Areas and Projects

    Science.gov (United States)

    studying realistic engine-in-vehicle operation, thermal management, component matching, advanced powertrain maximize the vehicle's performance. The vision of Thrust Area 1 is to create adaptive vehicles for maximum , victor.j.paul2.civ@mail.mil The safety and performance of human occupants and operators are paramount in the

  16. Environmental information document: Y Area

    International Nuclear Information System (INIS)

    Cook, J.R.; Grant, M.W.

    1986-01-01

    Site selection, facility descriptions, and alternative operations are described for disposal/storage of concentrated waste streams resulting from waste treatment facilities at the Savannah River Plant. Performance assessments and cost estimates for these alternatives are presented. The new disposal site for this waste will be designated Y Area

  17. Intelligent Carpooling in rural areas

    DEFF Research Database (Denmark)

    Agerholm, Niels; Møller, Jørgen

    2015-01-01

    in sufficient time (2-24 hours before). Another factor that has to be fulfilled is a high level of cohesion in the local area, i.e. a high level of knowledge of any participants in the scheme. Despite of these requirements being met, it is still a challenge to change car owners’ habit in order to make...

  18. Climatic change in Mediterranean area

    International Nuclear Information System (INIS)

    Manos, A.

    1991-01-01

    United Nations Environmental Program (UNEP) studies on forecasted greenhouse climatic effects on the Mediterranean coastal and marine ecosystems and regional socio-economic framework have indicated the need for a concerted plan of protective and remedial action. The studies considered rises of 1.5 degrees in ambient temperature and 20 centimeters in sea level occurring before the year 2025. A regional, as opposed to a global area, study approach was adopted since the severity of climatic effects is expected to vary greatly from one part of the world to another. The specific areas investigated were the Po River Delta and Venezia Lagoon in Italy, the Nile Delta, Camargue, the Ebro Delta, the Tunisian National Park area, and the Thermaicos Gulf in Greece. The rise in average temperature is expected to negatively effect Mediterranean agricultural production and the coastal and marine ecosystems due to prolonged periods of drought and exceptional rainfall. It is suggested that a system of dikes be constructed to protect the coastal areas which are heavily dependent on tourism and agriculture

  19. Upgrading of the West Area

    CERN Multimedia

    1983-01-01

    The rejigged main hall (EHW1) in the West Area: on background, below the crane, is the brown yoke of the Omega magnet which had been resited. The upgrading was completed by the time in July when 400 GeV protons arrived. See Annual Report 1983 p. 107.

  20. Main challenges of residential areas

    Directory of Open Access Journals (Sweden)

    Oana Luca

    2017-06-01

    Full Text Available The present article is a position paper aiming to initiate a professional debate related to the aspects related to the urban dysfunctions leading to the wear of the residential areas. The paper proposes a definition of the wear process, identify the main causes leading to its occurrence and propose a number of solutions to neutralise the dysfunctions. The three wearing phases of residential areas components are emphasized, exploring their lifecycle. In order to perform the study of urban wear, the status of the residential areas components can be established and monitored, and also the variables of the function that can mathematically model the specific wear process may be considered. The paper is considered a first step for the model adjustment, to be tested and validated in the following steps. Based on the mathematical method and model, there can be created, in a potential future research, the possibility of determining the precarity degree for residential areas/neighbourhoods and cities, by minimising the subjective component of the analyses preceding the decision for renovation or regeneration.

  1. COFFEE GROWING AREAS OF ETHIOPIA"

    African Journals Online (AJOL)

    accelerated economic growth, part of which is hoped to be achieved via increased ... at the Fifth International Conference on the Ethiopian Economy held at the United ... Samuel and Ludi: Agricultural commercialisation in coffee growing areas. ... Ethiopia produces and exports one of the best fighland coffees in the world.

  2. Wide area Hyperspectral Motion Imaging

    Science.gov (United States)

    2017-02-03

    detection at a manageable false alarm rate using the adaptive coherence estimator algorithm. A radiance spectrum was calculated with MODTRAN at 5km...1mHz. In order to meet SNR and update rate, the area coverage is reduced to less than the size of a football stadium. An interferometer has

  3. Zones 30 : urban residential areas.

    NARCIS (Netherlands)

    2006-01-01

    Sustainable Safety uses a road categorization in which through traffic is concentrated on motorways and other main roads. In residential areas, which have a living, shopping, or work function, through traffic is discouraged by setting a speed limit of 30 km/h, and by speed reducing measures such as

  4. Open areas and open access

    International Nuclear Information System (INIS)

    Thorndike, A.M.

    1979-01-01

    The main objective of the two open areas in the present ISABELLE design has been to provide flexibility with respect to the size and shape of experimental equipment that would eventually be installed there. No permanent building would be installed initially. One possibility would be to enclose each experiment in a temporary structure that would provide weatherproofing and shielding; another possibility would be to erect a permanent building at a later time, when experience has made the needs clearer than they are at present. The secondary objective of the design of open areas has been to keep initial costs as low as practicable. Another objective might be added, however, which we indicate by the term ''open access.'' This note will explore this idea and some design concepts based on it. In the ISABELLE 1977 summer workshop there was considerable discussion of the importance of techniques for inserting large pieces of experimental equipment quickly and removing them with equal ease and speed. Since enclosed halls have certain restrictions in this respect, open areas may be helpful in providing this feature. If the mechanical and electrical aspects could be handled quickly, one might even attempt to reduce the time spent on bureaucratic procedures in order to expedite the introduction of new experiments and new ideas in these areas

  5. GPS measurements in Satakunta area

    International Nuclear Information System (INIS)

    Poutanen, M.; Nyberg, S.; Ahola, J.

    2010-10-01

    The Finnish Geodetic Institute, the Geological Survey of Finland, Posiva Ltd and municipalities in the district of Satakunta launched the GeoSatakunta research program in 2002 to carry out interdisciplinary studies on regional bedrock stress field and to apply the results e.g. in land use planning in the Satakunta area. The area was chosen for many reasons. Its geological diversity, extensive multi-disciplinary data coverage, and various interests of participants made the area suitable for the project. The purpose of the GPS observations is to get detailed information on recent crustal deformations in the area. The Finnish Geodetic Institute maintains e.g. national GPS network, FinnRef, and since 1995 a local research network in the Olkiluoto area. The Satakunta network differs from these, and this is the first time to obtain such detailed information of a regional network in Finland. The Satakunta GPS network consists of 13 concrete pillars for episodic GPS campaigns and the Olkiluoto permanent GPS station in the FinnRef network. The distances between the concrete pillars are 10-15 km, and the sites were chosen in a co-operation with the Geological Survey of Finland taking into account the geological structures in the area. The City of Pori made the final reconnaissance in the field and constructed eight pillars in 2003. The original network was expanded in 2005-2006 in Eurajoki and Rauma, and at the City of Rauma joined the co-operation. The five new pillars join the previous Olkiluoto network into the Satakunta network. There have been three annual GPS campaigns in 2003-2008. Time series of the Satakunta network are shorter than in the Olkiluoto network, and also the distances are longer. Therefore, the same accuracy than in Olkiluoto has not yet achieved. However, mm-sized movements can be excluded. Estimated velocities were small (0.2 mm/a) and mostly statistically insignificant because of relatively short time series. In this publication we describe the

  6. [Emotion and Brodmann's areas: special reference on area 12].

    Science.gov (United States)

    Kawamura, Mitsuru

    2010-11-01

    Brodmann's brain maps, assembled in 1909, are still in use, but understanding of their animal-human homology is uncertain. Furthermore, in 1909, Brodmann did not identify human Area 12 (BA12); a location now important to understanding of frontotemporal lobar degeneration (FTLD) and emotional function. We found Brodmann did identify human BA12 in later maps (1910 and 1914), not in the 1909 monograph. Because of its current link with FTLD, BA 12's translation from animal (1909) to human (1910 and 1914) is not only an historical puzzle. It impacts how Brodmann's areas, based on comparative animal-human cyto-architecture, are widely used in current research as functional loci in human brain. If Brodmann's maps are of current value, then an accurate rather than a generic Brodmann number is in order.

  7. Conservative and innovative dialect areas

    Directory of Open Access Journals (Sweden)

    Christian Schwarz

    2014-12-01

    Full Text Available The present paper focuses on conservative and innovative (transitional dialect areas and the questions of 1 how such areas can be methodologically visualized and 2 how the outcomes can be interpreted. In the first part of this paper a geostatistical method of representing phonological features in space will be introduced: interpolation. This method is not entirely new to dialectology; it has been quite neglected, though, in comparison to other methods of mapping, such as the isogloss or dot symbol method that was mainly used in traditional dialect atlases. The interpolation method will be applied to a large corpus of spontaneous speech data from rural dialects spoken in southwest Germany. Methodological steps in data processing will be described, resulting in a data set that can be used as input for statistical analysis and the visual depiction of variation in space as interpolated grid plots. In the second part results will be discussed. The major outcome consists of an aggregate interpolation plot that includes variables from fifteen different etymological sound classes. These sound classes can be used for demonstrating the distribution of receding phonological variables in space. The interpolation shows two conservative areas where receding forms are still widespread. They lie within the centers of the two major dialect groups of southwest Germany: Alemannic and Swabian. The conservative areas are separated by a broad transitional zone characterized by intense variation between receding and innovative variants. It will be argued that this transitional zone is not due to the horizontal spread of the dialects into each other’s areas alone. Rather, variation is triggered by vertical standard influence that supports any dialect form to spread out horizontally as long as it is phonologically identical or similar to the standard form.

  8. Multitemporal burnt area mapping using Landsat 8: merging multiple burnt area indices to highlight burnt areas

    CSIR Research Space (South Africa)

    Vhengani, L

    2015-07-01

    Full Text Available gases. These, makes the study of wildfires important. The study of fires is in three phases. Firstly it is forecasting, which uses Fire Danger Index (FDI), secondly it is the mapping of active fires and thirdly, the mapping of burnt areas to access...

  9. [Endemic zoonosis in Mediterranean area].

    Science.gov (United States)

    Fenga, Concettina; Pugliese, Michela

    2013-01-01

    The Mediterranean is historically considered an area of high concentration of zoonoses. Mediterranean countries socio-economic features have favoured, over time, the onset of different types of zoonosis. Many of these may affect many occupational categories, first of all farmers, people working in abattoirs and processing products of animal origin. New farming activities and technologies have generated new occupational and zoonotic risks. These changes have influenced zoonosis epidemiology and have led to a gradual decrease in the number of diseases and to a reduction of some biological risks. However, brucellosis, Q fever, bovine tuberculosis cystic echinococcosis remain a strong example of zoonosis and a real risk, in the Mediterranean area especially. Therefore, an interdisciplinary collaboration between Veterinary Service, Public Health and Occupational medicine is necessary in order to plan territorial prevention.

  10. Tank Focus Area pretreatment activities

    International Nuclear Information System (INIS)

    McGinnis, C.P.; Welch, T.D.; Manke, K.L.

    1997-01-01

    Plans call for the high-level wastes to be retrieved from the tanks and immobilized in a stable waste form suitable for long-term isolation. Chemistry and chemical engineering operations are required to retrieve the wastes, to condition the wastes for subsequent steps, and to reduce the costs of the waste management enterprise. Pretreatment includes those processes between retrieval and immobilization, and includes preparation of suitable feed material for immobilization and separations to partition the waste into streams that yield lower life-cycle costs. Some of the technologies being developed by the Tank Focus Area (TFA) to process these wastes are described. These technologies fall roughly into three areas: (1) solid/liquid separation (SLS), (2) sludge pretreatment, and (3) supernate pretreatment

  11. Hanford 300 Area Development Plan

    International Nuclear Information System (INIS)

    Daly, K.S.; Seiler, S.W.; Hail, J.C.

    1991-09-01

    The purpose of the Hanford 300 Area Development Plan (Development Plan) is to guide the physical development of the 300 Area in accordance with US Department of Energy (DOE) Order 4320.1B (DOE 1991b) by performing the following: (1) Establishing a land use plan, setting land use categories that meet the needs of existing and proposed activities; (2) Coordinating existing, 5-yr, and long-range development plans and guiding growth in accordance with those plans; (3) Establishing development guidelines to encourage cost-effective development and minimize conflicts between adjacent activities; (4) Identifying site development issues that need further analysis; Integrating program plans with development plans to ensure a logical progression of development; and, (6) Integrating DOE plans with local agency plans (i.e., city, country, state, and Tri-Cities Science and Technology Park plans)

  12. Speleogenesis in Dinaric karst area

    Science.gov (United States)

    Garasic, Mladen; Garasic, Davor

    2015-04-01

    Dinaric Karst is one of the largest karst regions in Europe and in the World. It is the paramount karst of Europe and type site of many karst features. Dinaric Karst Area covers an extensive part of the Dinarides, a mountain chain in Southern Europe named after Dinara Mt., an impressive and outstanding rocky wall on the border between Dalmatian part of Croatia and Bosnia and Herzegovina. The Dinaric Karst occupies an area from the Friuli Plain (Doberdo Karst Plateau) and Slovenian mountains near Postojna cave on the northwest, to Skadar Lake and Prokletije Mt. on the southeast, from Central Bosnian Mountains on the northeast, and the Adriatic Sea seafloor with its islands. The Dinarides outspread in a so-called "Dinaric strike" (NW-SE) for 650 km in length and are up to 150 km wide across SW-NE. The biggest part of the Dinaric Karst Area is situated within Croatian territory (continental, Adriatic coastal and seafloor karst) comprising all karst features with exceptional examples exposed on the surface as well as in the underground. Classical karst area is the one situated in Slovenia, where typical karst features were described for the first time. Presentation of the outstanding values of Dinaric karst is based on the values that can be met in Italy, Bosnia and Herzegovina, Montenegro, Serbia and Albania, too. Dinaric Karst is the World's natural heritage because of its unique and outstanding geological characteristics and its living world; some of them are of outstanding natural beauty. Dinaric karst is an integral, compact karst area with extremely great thickness of carbonate rocks of predominantly Mesozoic age which in some areas exceeds 8.000 m. It bears several cycles of karstification thus giving world uniqueness to the area, especially regarding the wealth of submerged karst phenomena, among which vruljes are world unique features. Dinaric karst is one of the largest karst regions in the World. From the scientific perspective, the Dinaric Karst is one of

  13. Health care in rural areas.

    Science.gov (United States)

    Nath, L M

    1994-02-01

    In India, although the health care system infrastructure is extensive, the people often regard government facilities as family planning (FP) centers instead of primary health care centers. This problem has been compounded by the separation of health care and FP at all stages, even down to the storage of the same medication in two different locations depending upon whether it is to be used for "health" or for "FP." In rural areas where the government centers are particularly desolate, the community has chosen to erect its own health care system of private practitioners of all sorts and qualifications. Even in rural areas where a comprehensive health service is provided, with each household visited regularly by health workers, and where this service has resulted in a lowering of the crude death rate from 14.6 to 7 and the maternal mortality rate from 4.7 to 0.5/1000, people depend upon practitioners of various types. Upon analysis, it was discovered that the reason for using this multiplicity of practitioners had nothing to do with the level of satisfaction with the government service or with the accessibility of the services. Rather, when ill, the people make a diagnosis and then go to the proper place for treatment. If, for instance, they believe their malady was caused by the evil eye, they consult a magico-religious practitioner. These various types of practitioners flourish in areas with the best primary health care because they fulfill a need not met by the primary health care staff. If government agencies work with the local practitioners and afford them the proper respect, their skills can be upgraded in selected areas and the whole community will benefit.

  14. Temporary storage area characterization report

    International Nuclear Information System (INIS)

    1990-01-01

    The preferred alternative identified in the Remedial Investigation/Feasibility Study (RI/FS) for the Weldon Spring Quarry Bulk Wastes is to remove the wastes from the quarry and transport them by truck to temporary storage facility at the chemical plant site. To support the RI/FS, this report provides data to characterize the temporary storage area (TSA) site and to ensure the suitability of the proposed location. 31 refs., 14 figs., 7 tabs

  15. Nuclear criticality safety: 300 Area

    International Nuclear Information System (INIS)

    1991-01-01

    This Standard applies to the receipt, processing, storage, and shipment of fissionable material in the 300 Area and in any other facility under the control of the Reactor Materials Project Management Team (PMT). The objective is to establish practices and process conditions for the storage and handling of fissionable material that prevent the accidental assembly of a critical mass and that comply with DOE Orders as well as accepted industry practice

  16. Benzene exposures in urban areas

    International Nuclear Information System (INIS)

    Valerio, F.; Pala, M.; Cipolla, M.; Stella, A.

    2001-01-01

    Benzene exposures in urban areas were reviewed. Available data confirm that both in USA and Europe, benzene concentrations measured by fixed outdoor monitoring stations underestimate personal exposures of urban residents. Indoor sources, passive smoke and the high exposures during commuting time may explain this difference. Measures in European towns confirm that very frequently mean daily personal exposures to benzene exceed 10 μg/m 3 , current European air quality guideline for this carcinogenic compound [it

  17. An Incomplete Optimal Currency Area

    DEFF Research Database (Denmark)

    Dreyer, Johannes Kabderian; Graversen, Mads Byskov

    2014-01-01

    The main objective of this study is to test if the Eurozone a decade after its launch can be considered an optimal currency area (OCA) as defined by Mundell (1961). In an OCA, asymmetric shocks – as the ones experienced by the Eurozone following the recent financial crisis – may be dampened by tw...... on migration rates. We use panel regressions to test these relationships and find out that migration between member states is very low after the Euro’s first decade. Combined with the lack of significant fiscal transfers we conclude that the currency union is still not an OCA.......The main objective of this study is to test if the Eurozone a decade after its launch can be considered an optimal currency area (OCA) as defined by Mundell (1961). In an OCA, asymmetric shocks – as the ones experienced by the Eurozone following the recent financial crisis – may be dampened by two...... instruments: fiscal transfers from one country to another, or migration. As fiscal transfers in the Eurozone are low, we study the economic significance of migration flows as automatic stabilizers of the currency area. We assume that there is a strong relationship between unemployment and relative wealth...

  18. Innovation investment area: Technology summary

    Energy Technology Data Exchange (ETDEWEB)

    1994-03-01

    The mission of Environmental Management`s (EM) Office of Technology Development (OTD) Innovation Investment Area is to identify and provide development support for two types of technologies that are developed to characterize, treat and dispose of DOE waste, and to remediate contaminated sites. They are: technologies that show promise to address specific EM needs, but require proof-of-principle experimentation; and (2) already proven technologies in other fields that require critical path experimentation to demonstrate feasibility for adaptation to specific EM needs. The underlying strategy is to ensure that private industry, other Federal Agencies, universities, and DOE National Laboratories are major participants in developing and deploying new and emerging technologies. To this end, about 125 different new and emerging technologies are being developed through Innovation Investment Area`s (IIA) two program elements: RDDT&E New Initiatives (RD01) and Interagency Agreements (RD02). Both of these activities are intended to foster research and development partnerships so as to introduce innovative technologies into other OTD program elements for expedited evaluation.

  19. The problem with areas: Asia and Area studies

    Directory of Open Access Journals (Sweden)

    Victor T. King

    2012-09-01

    Full Text Available Review of:Goh Beng Lan (ed., Decentring & diversifying Southeast Asian Studies: Perspectives from the region. Singapore: ISEAS, 2011, xiii + 304 pp. ISBN 9789814311564, price: USD 34.90 (paperback; 9789814311571, USD 45.90 (hardback.Terence Wesley-Smith and Jon Goss (eds, Remaking Area studies: Teaching and learning across Asia and the Pacific. Honolulu: University of Hawai‘i Press, 2010, xxvii + 243 pp. ISBN 9780824833213. Price: USD 45.00 (hardback.Jacob Edmond, Henry Johnson and Jacqueline Leckie (eds, Recentring Asia: Histories, encounters, identities, xv + 339 pp. Leiden/Boston: Brill, Global Oriental: 2011. ISBN 9781906876258. Price: EUR 80.00 (hardback.

  20. RAINWATER MANAGEMENT IN PROTECTED AREAS

    Directory of Open Access Journals (Sweden)

    Wioletta Żarnowiec

    2017-03-01

    Full Text Available The aim of the study was to find out whether the climate of the southern Poland allows for removing rainwater from industrial areas by evaporation from roof surfaces. The study covered the premises of a Logistics Centre with an approximate area of 34 hectares, located in the catchment of the Wedonka stream and in the region of water intake for Kraków at the Rudawa river. In the future, the Centre will comprise nine large warehouses. Road traffic associated with the project will cause potential risks for groundwater and surface water of this protected area. Therefore, the Centre’s investor decided to evaporate rainwater from the premises. To establish advisability of this plan, the study team designed and built a unique experimental station consisting of experimental roof, tank for collecting water for the sprinkler system, system for delivering, distributing and discharging water from the roof, measuring tilt tray, automatic meteorological station, and electronic devices for recording measurement data. The research on the experimental station was carried out from April to October in 2011 and 2012 and included continuous measurements of the volume of water supplied to and discharged from the roof. Moreover, the temperature of the roof and water in the tank and a number of important meteorological parameters were measured. The difference between supplied and discharged water, divided by the wetted surface of the roof, helped to determine thickness of the evaporation layer in millimeters. The study confirmed the possibility of removing potentially contaminated rainwater by evaporating it from roof surfaces of the Logistics Centre located near Kraków at an average rate of 5.9 dm3·m–2.d–1. However, due to high seasonal variability of rainfall and air temperature, it is necessary to temporarily collect water in an expansion tank of suitable capacity.

  1. AEC controlled area safety program

    International Nuclear Information System (INIS)

    Hendricks, D.W.

    1969-01-01

    The detonation of underground nuclear explosives and the subsequent data recovery efforts require a comprehensive pre- and post-detonation safety program for workers within the controlled area. The general personnel monitoring and environmental surveillance program at the Nevada Test Site are presented. Some of the more unusual health-physics aspects involved in the operation of this program are also discussed. The application of experience gained at the Nevada Test Site is illustrated by description of the on-site operational and safety programs established for Project Gasbuggy. (author)

  2. Western Areas new U plant

    International Nuclear Information System (INIS)

    Anon.

    1982-01-01

    On March 30, 1982 Western Areas Gold Mining Company Limited's uranium plant was officialy opened. The plant is designed to treat 100 000t/month of uranium bearing ore. The majority of this ore is from the Middle Elsburg series, while the miner part comes from routing upgrated Upper Elsburg products into the uranium plant treatment route. The forward leach concept of gold and uranium extraction is adopted, i.e. the gold is extracted before the uranium. The flow of work, instrumentation, electrical installation and other facilities at the plant are also discussed

  3. Carlsbad Area Office strategic plan

    International Nuclear Information System (INIS)

    1995-10-01

    This edition of the Carlsbad Area Office Strategic Plan captures the U.S. Department of Energy's new focus, and supercedes the edition issued previously in 1995. This revision reflects a revised strategy designed to demonstrate compliance with environmental regulations earlier than the previous course of action; and a focus on the selected combination of scientific investigations, engineered alternatives, and waste acceptance criteria for supporting the compliance applications. An overview of operations and historical aspects of the Waste Isolation Pilot Plant near Carlsbad, New Mexico is presented

  4. Rurality study of restricted areas

    Directory of Open Access Journals (Sweden)

    Sergio Rivaroli

    2011-02-01

    Full Text Available Two main perspectives of investigation emerge from the study of a territory’s rurality: a geographical approach and a sociological approach. The research examines the sub-regional study case of ‘Nuovo circondario imolese’. The analysis shows that the combination of traditional institutional criteria with detailed informations about the territory, generates more accurate results which determine a better comprehension of the characteristics of restricted areas’ rurality. Over the period 1991-2001, the study highlights an increase in rural areas. This result could be interpreted as an effect of urban sprawl’s intensification, that increases the competition between non-farm residences and agricultural activities.

  5. History of 100-B Area

    International Nuclear Information System (INIS)

    Wahlen, R.K.

    1989-10-01

    The initial three production reactors and their support facilities were designated as the 100-B, 100-D, and 100-F areas. In subsequent years, six additional plutonium-producing reactors were constructed and operated at the Hanford Site. Among them was one dual-purpose reactor (100-N) designed to supply steam for the production of electricity as a by-product. Figure 1 pinpoints the location of each of the nine Hanford Site reactors along the Columbia River. This report documents a brief description of the 105-B reactor, support facilities, and significant events that are considered to be of historical interest. 21 figs

  6. AEC controlled area safety program

    Energy Technology Data Exchange (ETDEWEB)

    Hendricks, D W [Nevada Operations Office, Atomic Energy Commission, Las Vegas, NV (United States)

    1969-07-01

    The detonation of underground nuclear explosives and the subsequent data recovery efforts require a comprehensive pre- and post-detonation safety program for workers within the controlled area. The general personnel monitoring and environmental surveillance program at the Nevada Test Site are presented. Some of the more unusual health-physics aspects involved in the operation of this program are also discussed. The application of experience gained at the Nevada Test Site is illustrated by description of the on-site operational and safety programs established for Project Gasbuggy. (author)

  7. Home area networks and IPTV

    CERN Document Server

    Rémy, Jean-Gabriel

    2013-01-01

    The field of Home Area Networks (HAN), a dedicated residential subset of LAN technologies for home-based use, is fast becoming the next frontier for the communications industry.This book describes the various technologies involved in the implementation of a HAN: high-speed Internet connections, indoor implementations, services, software, and management packages. It also reviews multimedia applications (which are increasingly the most important and complex aspects of most HANs) with a detailed description of IPTV technology. It highlights the main technologies used for HANs: information tra

  8. Area-normalized thematic views

    Energy Technology Data Exchange (ETDEWEB)

    Keahey, T.A.

    1998-10-01

    This paper presents a novel technique for dealing with a classic problem that frequently arises in visualization. Very expressive nonlinear transformations can be automatically generated to correct thematic maps so that the areas of map regions are proportional to the thematic variables assigned to them. This helps to eliminate one of the most commonly occurring visual lies that occurs in information visualization. Thematic variables are commonly used in cartography to encode additional information within the spatial layout of a map. Common examples of thematic variables are population density, pollution level and birth rate. The method is illustrated with two examples, mapping interstate speed limits and presidential election results.

  9. Large area and flexible electronics

    CERN Document Server

    Caironi, Mario

    2015-01-01

    From materials to applications, this ready reference covers the entire value chain from fundamentals via processing right up to devices, presenting different approaches to large-area electronics, thus enabling readers to compare materials, properties and performance.Divided into two parts, the first focuses on the materials used for the electronic functionality, covering organic and inorganic semiconductors, including vacuum and solution-processed metal-oxide semiconductors, nanomembranes and nanocrystals, as well as conductors and insulators. The second part reviews the devices and applicatio

  10. Wide area continuous offender monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Hoshen, J. [Lucent Technologies (United States); Drake, G. [New Mexico Dept. of Corrections, Santa Fe, NM (United States); Spencer, D. [Sandia National Labs., Albuquerque, NM (United States)

    1996-11-01

    The corrections system in the U.S. is supervising over five million offenders. This number is rising fast and so are the direct and indirect costs to society. To improve supervision and reduce the cost of parole and probation, first generation home arrest systems were introduced in 1987. While these systems proved to be helpful to the corrections system, their scope is rather limited because they only cover an offender at a single location and provide only a partial time coverage. To correct the limitations of first-generation systems, second-generation wide area continuous electronic offender monitoring systems, designed to monitor the offender at all times and locations, are now on the drawing board. These systems use radio frequency location technology to track the position of offenders. The challenge for this technology is the development of reliable personal locator devices that are small, lightweight, with long operational battery life, and indoors/outdoors accuracy of 100 meters or less. At the center of a second-generation system is a database that specifies the offender`s home, workplace, commute, and time the offender should be found in each. The database could also define areas from which the offender is excluded. To test compliance, the system would compare the observed coordinates of the offender with the stored location for a given time interval. Database logfiles will also enable law enforcement to determine if a monitored offender was present at a crime scene and thus include or exclude the offender as a potential suspect.

  11. IMAGE INTERPRETATION OF COASTAL AREAS

    Directory of Open Access Journals (Sweden)

    M. A. Lazaridou

    2012-07-01

    Full Text Available Coasts were formed with the overall shape of earth's surface. Τhey represent a landform, as determined by the science of geomorphology. Being the boundary between land and sea, they present important features – particularities such as water currents, waves, winds, estuaries, drainage network, pollution etc. Coasts are examined at various levels: continents – oceans, states – large seas, as for example Mediterranean Sea. Greece, because of its horizontal and vertical partitioning, presents great extent and variety of coasts as mainland, peninsulas and islands. Depending on geomorphology, geology, soils, hydrology, land use of the inland and the coasts themselves, these are very diverse. Photogrammetry and Remote Sensing (defined by Statute II of ISPRS is the art, science, and technology of obtaining reliable information from non-contact imaging and other sensor systems about the Earth and its environment, and other physical objects and of processes through recording, measuring, analyzing and representation. This paper concerns critical considerations on the above. It also includes the case of Thessaloniki coasts in Greece, particularly river estuaries areas (river delta. The study of coastal areas of the wide surroundings of Thessaloniki city includes visual image interpretation – digital image processing techniques on satellite data of high spatial resolution.

  12. Innovation investment area: Technology summary

    International Nuclear Information System (INIS)

    1994-03-01

    The mission of Environmental Management's (EM) Office of Technology Development (OTD) Innovation Investment Area is to identify and provide development support for two types of technologies that are developed to characterize, treat and dispose of DOE waste, and to remediate contaminated sites. They are: technologies that show promise to address specific EM needs, but require proof-of-principle experimentation; and (2) already proven technologies in other fields that require critical path experimentation to demonstrate feasibility for adaptation to specific EM needs. The underlying strategy is to ensure that private industry, other Federal Agencies, universities, and DOE National Laboratories are major participants in developing and deploying new and emerging technologies. To this end, about 125 different new and emerging technologies are being developed through Innovation Investment Area's (IIA) two program elements: RDDT ampersand E New Initiatives (RD01) and Interagency Agreements (RD02). Both of these activities are intended to foster research and development partnerships so as to introduce innovative technologies into other OTD program elements for expedited evaluation

  13. 300 Area signal cable study

    International Nuclear Information System (INIS)

    Whattam, J.W.

    1994-01-01

    This report was prepared to discuss the alternatives available for removing the 300 Area overhead signal cable system. This system, installed in 1969, has been used for various monitoring and communication signaling needs throughout the 300 Area. Over the years this cabling system has deteriorated, has been continually reconfigured, and has been poorly documented to the point of nonreliability. The first step was to look at the systems utilizing the overhead signal cable that are still required for operation. Of the ten systems that once operated via the signal cable, only five are still required; the civil defense evacuation alarms, the public address (PA) system, the criticality alarms, the Pacific Northwest Laboratory Facilities Management Control System (FMCS), and the 384 annunciator panel. Of these five, the criticality alarms and the FMCS have been dealt with under other proposals. Therefore, this study focused on the alternatives available for the remaining three systems (evacuation alarms, PA system, and 384 panel) plus the accountability aid phones. Once the systems to be discussed were determined, then three alternatives for providing the signaling pathway were examined for each system: (1) re-wire using underground communication ducts, (2) use the Integrated Voice/Data Telecommunications System (IVDTS) already installed and operated by US West, and (3) use radio control. Each alternative was developed with an estimated cost, advantages, and disadvantages. Finally, a recommendation was provided for the best alternative for each system

  14. Open areas and open access

    International Nuclear Information System (INIS)

    Thorndike, A.M.

    1978-01-01

    One objective of the two open areas in the present ISABELLE design is to provide flexibility with respect to the size and shape of experimental equipment that would eventually be installed there. No permanent building would be installed initially. A second objective of the design of open areas is to keep initial costs as low as practicable. Another objective is open access. This note explores this idea and some design concepts based on it. It would permit inserting large pieces of experimental equipment quickly and removing them with equal ease and speed. Entire experiments would be moved in a single piece (or a few) by building them on movable platforms with capacities of up to about 1000 tons per platform. Most experiments could be built on a single platform or on a few. The shielding must also be moved. It must also be organized into a small number of large units. A scheme using large tanks filled with water is described. It is important to make the equipment on a given platform as complete and self-contained as possible, with a minimum of interconnections for power, coolant, controls, data transmission, etc. 5 figures

  15. HYDROGELS AND THEIR APLICATION AREAS

    Directory of Open Access Journals (Sweden)

    AÇIKEL Safiye Meriç

    2016-05-01

    Full Text Available Hydrogels, being polymeric material,are named “Hydrophilic Polymer” because of their capable of holding large amounts of water in their three-dimensional networks. Hydrogels is not solved in water; however they have been swollen to their balace volume. Because of this swell behavior, they can adsorb big quantity of water in this structure. So they can term of “three sized polymers” due to protect their existing shape. Their cross linked bound structures are able to covalent or ionic and also one polymer which can for use of hydrogel polymer, must have hydrophilic groups such as carboxyl, carbonyl, amine and amide in main chains or side chains, and because of these groups water bound the polymer and polymer start to swell with rising volume and mass. Swell behavior of hydrogel is interested in quantity of hydrophilic groups. Hydrogels can use in different industrial and environmental areas with this high amount water holding capacity. They are used in food industry, biomedical, bioengineering, biotechnology, veterinary, pharmacist, agriculture, telecommunication, etc. Especially in current life, baby nappy has been including inside hydrogel beads. Also they used in contact lens, artificial cornea, synthetic cartilage and gullet, controlled medicine release, surgery yarns. This article general inform about usage area of hydrogels.

  16. Organizational Dysfunctions: Sources and Areas

    Directory of Open Access Journals (Sweden)

    Jacek Pasieczny

    2016-12-01

    Full Text Available Objective:The purpose of this article is to identify and describe various types and sources of organizational dysfunctions. Research Design & Methods: The findings are based on literature review and an ongoing empirical research project conducted in private sector organisations. The empirical study can be situated within interpretative approach. In this qualitative project open interviews and observations were used to collect data. Findings: The study indicates that various types and sources of organizational dysfunctions can be identified in organizations operating in Poland. The sources of dysfunctions may be found both within the organization and its environment. Regardless of its specific features, most of the dysfunctions may be interpreted as an undesirable goal displacement. Very often areas of these dysfunctions are strongly interconnected and create a system that hinders organizational performance. Yet, it is difficult to study these phenomena as respondents are unwilling, for various reasons, to disclose the problems faced by their organizations. Implications & Recommendations: The results imply that the issue of organisational dysfunctions requires open, long-lasting and comparative studies. Recommendations for further studies are formulated in the last section of the paper. Contribution & Value Added: The paper provides insight into "the dark side of organising" by identifying sources and areas of dysfunctions. It also reveals difficulties connected with conducting research on dysfunctions in the Polish context.

  17. X-ray area monitor

    International Nuclear Information System (INIS)

    Nintrakit, N.

    1983-01-01

    The X-ray area monitor is a nuclear electronic device that is essential in radiation protection in high radiation laboratories, e.g. in medical diagnosis using X-rays and in industrial X-radiography. Accidentally the level of X-radiator may arise above the safe permissible level and in such a case the alarm system of the area monitor will work and disconnect the ac power supply form the X-ray unit. Principally the device is a radiation counter using G.M.tube as radiation detector with high voltage supply variable form 200 to 2,000 volts. The maximum count rate of the scaler is 1.5 MHz and the total count is displayed on 4 digit LED's. A time base is used to control the counting time, the frequency multiplier, radiation safety limit, comparator and the radiation hazard warning signal. The reliability of the instrument is further enhanced through the addition of the random correction circuit, and it is applicable both in X- and γ -radiation

  18. Geodiversity assessment in urban areas

    Science.gov (United States)

    Ilic, Marina; Stojković, Sanja; Rundić, Ljupko; Ćalić, Jelena; Sandić, Dejan

    2017-04-01

    Conflict over natural resources figured prominently in the urban areas. On the one hand there is a constant need for space for the construction of new buildings for housing, agriculture and industrial production, and on the other hand the resources need protection because of the threat of degradation or even complete destruction. Considering the fact that urbanization is one of the most serious threats to geodiversity, it is important that this issue is taken into account in spatial development plans and georesource management strategies in urban areas. The geodiversity, as well as natural resource, must be managed in a sustainable manner in which it is very important its protection. The mapping of specific categories of geodiversity (geological, geomorphological, hydrological and soil) on the basis of quantitative assessment with the use of Geographic Information Systems (GIS) can allow spatial planners and managers to take further steps that would reduce threats and protect the natural values. This work presents the application of geodiversity evaluation method by using the geodiversity index (Gd), based on the quantity of abiotic elements and relief roughness within a spatial unit in the case of the City of Belgrade, Serbia. The acquired results are analyzed in the context of sustainable use of georesources and the threats to which geodiversity is exposed due to the development of the city.

  19. [Blood donation in urban areas].

    Science.gov (United States)

    Charpentier, F

    2013-05-01

    Medical and technical developments increase the difficulty to provide sufficient safe blood for all patients in developed countries and their sociodemographic and societal changes. Sufficient national blood supply remains a reached, however still actual, challenge. Tomorrow is prepared today: the management of blood donation programs both in line with these developments and with social marketing strategies is one of the keys to success. If the main components of this organization are well known (mobile blood drives in various appropriate environments, and permanent blood donation centers) their proportions in the whole process must evolve and their contents require adaptations, especially for whole blood donation in urban areas. We have to focus on the people's way of life changes related to increasing urbanization of the society and prominent position taken by very large cities. This requires targeting several goals: to draw the attention of the potential blood-giving candidate, to get into position to collect him when he will decide it, to give meaning and recognition to his "sacrifice" (give time rather than donate blood) and to give him desire and opportunity to come back and donate one more time. In this strategy, permanent blood centers in urban areas have significant potential for whole blood collection, highlighted by the decrease of apheresis technology requirements. This potential requires profound changes in their location, conception and organization. The concept of Maison Du Don (MDD) reflects these changes. Copyright © 2013. Published by Elsevier SAS.

  20. 75 FR 32099 - Enterprise Duty To Serve Underserved Markets

    Science.gov (United States)

    2010-06-07

    ... throughout the nation.\\5\\ \\4\\ See 12 U.S.C. 1716 et seq.; 12 U.S.C. 1451 et seq. \\5\\ Id. B. Statutory... develop and present to Congress a plan for the future of the nation's housing finance system that will...). See also Consumer Federation of America, ``The Promise and Pitfalls of Building Wealth through...

  1. 77 FR 25779 - SBA Council on Underserved Communities

    Science.gov (United States)

    2012-05-01

    ... CONTACT: The meeting is open to the public however advance notice of attendance is requested. Anyone... contact Nicole Nelson by May 3rd 2010, by fax or email in order to be placed on the agenda. [[Page 25780

  2. AIDS Prevention for the Underserved Majority : the Choice Disabled ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Renforcement de la capacité de mener des essais de prévention de la transmission du VIH au personnel de la santé. Les travailleurs de la santé constituent un groupe prioritaire pour les essais de prévention de la transmission du VIH puisqu'ils représentent un nombre relativement important de personnes à.

  3. Myths and misconceptions about abortion among marginalized underserved community.

    Science.gov (United States)

    Thapa, K; Karki, Y; Bista, K P

    2009-01-01

    Unsafe abortion remains a huge problem in Nepal even after legalization of abortion. Various myths and misconceptions persist which prompt women towards unsafe abortive practices. A qualitative study was conducted among different groups of women using focus group discussions and in depth interviews. Perception and understanding of the participants on abortion, methods and place of abortion were evaluated. A number of misconceptions were prevalent like drinking vegetable and herbal juices, and applying hot pot over the abdomen could abort pregnancy. However, many participants also believed that health care providers should be consulted for abortion. Although majority of the women knew that they should seek medical aid for abortion, they were still possessed with various misconceptions. Merely legalizing abortion services is not enough to reduce the burden of unsafe abortion. Focus has to be given on creating awareness and proper advocacy in this issue.

  4. AIDS Prevention for the Underserved Majority : the Choice Disabled ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Yet health resources are generally poorly optimized for prevention and almost without exception focused on ... various AIDS prevention interventions on the choice-disabled, with a special focus on victims of sexual violence. ... Journal articles.

  5. Focus Cities : Improving the Living Environment in Underserved ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Papers. Urban Poverty and Environment Programme : Colombo; monitoring and evaluation component; monitoring findings as of December 2008 - April 2009; outcome mapping no. 2. 129292.pdf. Papers. Statistical handbook on baseline survey : part 1; data tables; (Focus City Programme : Community based Assessment ...

  6. Mammographic Breast Density in a Cohort of Medically Underserved Women

    Science.gov (United States)

    2015-12-01

    was a training year and during Years 2 through 4 a case-control study of obesity , insulin resistance and mammographic breast density was conducted. A...factors including health literacy, and to collect anthropometric measurements and fasting blood, 3) to assay blood for select hormones and growth...factors, 4) to perform statistical analyses to determine the associations between obesity and insulin resistance and mammographic breast density, and 5

  7. Beyond Blackboards: Engaging Underserved Middle School Students in Engineering.

    Science.gov (United States)

    Blanchard, Sarah; Judy, Justina; Muller, Chandra; Crawford, Richard H; Petrosino, Anthony J; White, Christina K; Lin, Fu-An; Wood, Kristin L

    Beyond Blackboards is an inquiry-centered, after-school program designed to enhance middle school students' engagement with engineering through design-based experiences focused on the 21 st Century Engineering Challenges. Set within a predominantly low-income, majority-minority community, our study aims to investigate the impact of Beyond Blackboards on students' interest in and understanding of engineering, as well as their ability to align their educational and career plans. We compare participants' and nonparticipants' questionnaire responses before the implementation and at the end of the program's first academic year. Statistically significant findings indicate a school-wide increase in students' interest in engineering careers, supporting a shift in school culture. However, only program participants showed increased enjoyment of design-based strategies, understanding of what engineers do, and awareness of the steps for preparing for an engineering career. These quantitative findings are supported by qualitative evidence from participant focus groups highlighting the importance of mentors in shaping students' awareness of opportunities within engineering.

  8. Deconstructing "Bistro 24" for a Traditionally Underserved Student Population

    Science.gov (United States)

    Thomas, Charles E.

    2016-01-01

    The "Journal of Legal Studies Education" article, "Step Away from the Syllabus: Engaging Students on the First Day of Legal Environment," encouraged instructors to rethink their approaches to the initial class session. The exercise offers an opportunity to introduce the relevance of the legal environment course within the…

  9. 78 FR 28274 - Council on Underserved Communities, Re-Establishment

    Science.gov (United States)

    2013-05-14

    ... Tuesday, May 21, 2013 from 2:30 p.m. to 3:30 p.m. Eastern Daylight Savings Time. FOR FURTHER INFORMATION... issuing this notice to announce the date, time, and agenda for the first meeting of the SBA Council on...

  10. Focus Cities : Improving the Living Environment in Underserved ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    IDRC's Focus Cities research program brings together researchers, municipal authorities, civil society organizations, the private sector and the poor to engage in urban environmental research with the goal of alleviating urban poverty. This project was selected as one of the four highest ranked in the 2005 Focus Cities ...

  11. AIDS Prevention for the Underserved Majority : the Choice Disabled ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Download PDF. Journal articles. Gender-specific patterns of multiple concurrent sexual partnerships : a national cross sectional survey in Botswana. Download PDF. Journal articles. Community views of inter-generational sex : findings from focus groups in Botswana, Namibia and Swaziland. Download PDF. Journal articles.

  12. Regionally Significant Ecological Areas - MLCCS derived 2008

    Data.gov (United States)

    Minnesota Department of Natural Resources — This is an analysis of regionally significant Terrestrial and Wetland Ecological Areas in the seven county metropolitan area. Individual forest, grassland and...

  13. Central Region Regionally Ecological Significant Areas

    Data.gov (United States)

    Minnesota Department of Natural Resources — This is an analysis of regionally significant Terrestrial and Wetland Ecological Areas in the seven county metropolitan area. Individual forest, grassland and...

  14. Resource area environment/energy

    International Nuclear Information System (INIS)

    1994-01-01

    The document comprises a detailed analysis of the business economics of resources related to energy and the environment. Non-domestic and domestic conditions influencing the business economics of this subject area, its infrastructure, problems and future perspectives are dealt with. Tables (amongst other forms of information) indicate the turnover, exports, and numbers of involved employees, workplaces and firms involved in supply, general production, consultancy and production connected with the building sector. The energy sector is the most significant in this respect, giving 30,000 employed (18% in state institutions), a turnover of 63 billion Danish kroner, and with an export of 16 billion Danish kroner. The environmental sector employs 15,000 (29% in the public sector), the total turnover is 20 billion Danish kroner and of this 3 billion Danish kroner is related to export. Many firms are relatively small. A number of firms could compete internationally and this number is growing. (AB) (79 refs.)

  15. Ashland Area Support Substation Project

    International Nuclear Information System (INIS)

    1992-06-01

    The Bonneville Power Administration (BPA) provides wholesale electric service to the City of Ashland (the City) by transferring power over Pacific Power ampersand Light Company's (PP ampersand L) 115-kilovolt (kV) transmission lines and through PP ampersand L's Ashland and Oak Knoll Substations. The City distributes power over a 12.5-kV system which is heavily loaded during winter peak periods and which has reached the limit of its ability to serve peak loads in a reliable manner. Peak loads under normal winter conditions have exceeded the ratings of the transformers at both the Ashland and Oak Knoll Substations. In 1989, the City modified its distribution system at the request of PP ampersand L to allow transfer of three megawatts (MW's) of electric power from the overloaded Ashland Substation to the Oak Knoll Substation. In cooperation with PP ampersand L, BPA installed a temporary 6-8 megavolt-amp (MVA) 115-12.5-kV transformer for this purpose. This additional transformer, however, is only a temporary remedy. BPA needs to provide additional, reliable long-term service to the Ashland area through additional transformation in order to keep similar power failures from occurring during upcoming winters in the Ashland area. The temporary installation of another 20-MVA mobile transformer at the Ashland Substation and additional load curtailment are currently being studied to provide for sustained electrical service by the peak winter period 1992. Two overall electrical plans-of-service are described and evaluated in this report. One of them is proposed for action. Within that proposed plan-of-service are location options for the substation. Note that descriptions of actions that may be taken by the City of Ashland are based on information provided by them

  16. Precipitation interpolation in mountainous areas

    Science.gov (United States)

    Kolberg, Sjur

    2015-04-01

    Different precipitation interpolation techniques as well as external drift covariates are tested and compared in a 26000 km2 mountainous area in Norway, using daily data from 60 stations. The main method of assessment is cross-validation. Annual precipitation in the area varies from below 500 mm to more than 2000 mm. The data were corrected for wind-driven undercatch according to operational standards. While temporal evaluation produce seemingly acceptable at-station correlation values (on average around 0.6), the average daily spatial correlation is less than 0.1. Penalising also bias, Nash-Sutcliffe R2 values are negative for spatial correspondence, and around 0.15 for temporal. Despite largely violated assumptions, plain Kriging produces better results than simple inverse distance weighting. More surprisingly, the presumably 'worst-case' benchmark of no interpolation at all, simply averaging all 60 stations for each day, actually outperformed the standard interpolation techniques. For logistic reasons, high altitudes are under-represented in the gauge network. The possible effect of this was investigated by a) fitting a precipitation lapse rate as an external drift, and b) applying a linear model of orographic enhancement (Smith and Barstad, 2004). These techniques improved the results only marginally. The gauge density in the region is one for each 433 km2; higher than the overall density of the Norwegian national network. Admittedly the cross-validation technique reduces the gauge density, still the results suggest that we are far from able to provide hydrological models with adequate data for the main driving force.

  17. Malaysia (country/area statements).

    Science.gov (United States)

    1985-09-01

    According to this statement presented to the Committee on Population of the UN Economic and Social Commission for Asia and the Pacific, Malaysia by 1984 achieved a crude death rate of 5.3/1000, an infant mortality rate of 17/1000 live births, and a 1983 life expectancy at birth of 67.6 for males and 72.3 for females due primarily to socioeconomic development, better nutrition, and a health system covering 95% of the rural population. Substantial mortality differentials still exist between Peninsular Malaysia, Sabah, and Sarawak, between urban and rural areas, and among ethnic groups. Differences in the coverage and quality of mortality statistics also exist. 83.2% of Malaysia's total population of 15.5 million is in Peninsular Malaysia, 7.3% in Sabah, and 9.5% in Sarawak. In Peninsular Malaysia, 55.1% are Malays, 33.9% Chinese, and 10.3% Indians. About 40% of the population is urban, and 39% is under age 15. The average annual rate of growth declined from 2.6% in the 1960s to 2.3% in the 1970s. The total fertility rate fell from 5.1 children in 1970 to 4.1 in 1980. A rise in age at 1st marriage and reduction in marital fertility have been partly offset by an increase in the proportion of women of childbearing age. The population is projected to grow to about 22 million by the year 2000. Chinese and Indians are expected to approach replacement level fertility by that year, but Malay fertility is expected to remain high for some time. Internal migration, 45% of which is intrarural, increased markedly in the 1970s, probably due to rapid modernization, industrialization, land development, and regional imbalances in economic development. In absolute terms a total of 410,000 persons moved from rural to urban areas during the 1970s. Important progress has been made in regional development programs, but further regional development requires resolution of problems related to internal migration and greater efforts to relocate industries in the less developed areas. The

  18. Lp-dual affine surface area

    Science.gov (United States)

    Wei, Wang; Binwu, He

    2008-12-01

    According to the notion of Lp-affine surface area by Lutwak, in this paper, we introduce the concept of Lp-dual affine surface area. Further, we establish the affine isoperimetric inequality and the Blaschke-Santaló inequality for Lp-dual affine surface area. Besides, the dual Brunn-Minkowski inequality for Lp-dual affine surface area is presented.

  19. A model for lightning in littoral areas

    NARCIS (Netherlands)

    Blaj, M.A.; Leferink, Frank Bernardus Johannes

    2009-01-01

    The littoral or coastal areas are different compared to the maritime or continental areas considering lightning. Only the last years some research about these areas has been carried out. The need for a model, regarding the lightning activity in these areas is much needed. And now, with the changes

  20. 5 CFR 351.402 - Competitive area.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Competitive area. 351.402 Section 351.402... Competition § 351.402 Competitive area. (a) Each agency shall establish competitive areas in which employees compete for retention under this part. (b) A competitive area must be defined solely in terms of the...

  1. A unique radiation area monitoring system

    International Nuclear Information System (INIS)

    Murphy, P.C.; Allen, G.C.

    1978-01-01

    The Remote Area Monitoring Systems (RAMS) monitors four radiation areas with two independent systems in each area. Each system consists of power supplies, four ionization chambers, and four analog and digital circuits. The first system controls the warning beacons, horns, annunciation panel and interlocks. The second system presents a quantitative dose rate indication at the console and in the radiation area

  2. AIR POLLUTION OF URBAN AREAS

    Directory of Open Access Journals (Sweden)

    MAKAROVA V. N.

    2016-04-01

    Full Text Available Raising of problem. Any manufacturing processes related to the generation of waste. Year after year, a growing mass of waste is one of the main factors reducing the quality of the environment and destruction of natural landscapes. Industrial development inevitably enhances human impacts on the environment and disrupts the ecological balance [3]. Atmospher air is a vital element of the environment. The development of industry, the growth of cities, increasing the number of transport, active exploration of near-Earth space lead to a change in the gas composition of the atmosphere and disruption of its natural balance. Air quality affects the health of the population [5]. Without water or food a person can do for a while, but without air he can not live a few minutes, therefore saving air breathable is an urgent problem. Purpose. The results of geological studies clearly indicate that the contamination of the surface layer of the atmosphere is the most powerful permanent factor of influence on the human food chain and the environment. This problem was reflected in the scientific literature [2; 3; 6], and the second significant indicator of ecological well-being of the region is the number of generation and accumulation of waste. According to this indicator, Dnipropetrovsk region is in the lead, as relates to the industrialized regions. The idea of the article is to consider the air pollution of the urban environment in terms of the accumulation of waste in the territory of enterprises, in particular slag dumps metallurgical production. Conclusion. Slag dumps located on the premises are a significant source of air pollution urbanized areas due to the permanent nature of the spread of contamination. Slag dump of PAT "Nikopol Ferroalloy Plant" is a source of manganese, zinc, nickel emissions. As a conclusion about the magnitude of pollution of the atmospheric boundary layer can say the following: on the border of the sanitary protection zone (SPZ, in

  3. Saraniyadhamma Community knowledge Incubator area

    Directory of Open Access Journals (Sweden)

    Siripong Arundechachai

    2017-03-01

    Full Text Available The purposes of this research were to 1 study the situation of the community knowledge incubator area at the past to the present time in Banhad,Tambon banhad, Amphoe banhad Changwat KhonKaen, 2 study guidelines Buddhadhamma “Saraniyadhamma” revised by Community knowledge application Banhad, Tambon banhad, Amphoe banhad Changwat KhonKaen, 3 study workflow of Saraniyadhamma that led to the creation of the network community knowledge incubator area together with another community. The target groups used in this research of the purposive sampling family farmers of 10, in Tambon banhad,Amphoe banhad Changwat KhonKaen. the Qualitative research.was used in this Study The results showed that 1 diversing issues in the Community live action of the relationships or occupations experience can be passed down, as well as the risk of loss the relationships between the people and people, people and supernatural. After people and nature lost in the community, but thay Continue to Perform, because community has strengths given the importance of all, to themselves, to others, generous, generosity, mounting traditions, Led to the creation Community Knowledge Incubator 2 adopting Buddhism’s “Saraniyadhamma 6” that applied to community Knowledge Incubator by giving to make immunity community. Strong The six fetures, were Principle 1: Metta-kayakamma, feature on sacrifiction, unity and synergy. Principle 2: Metta-manokamma, feature on mercifulness, collective sacrification. Principle 3: Metta-kayakamma, feature on good things, speak well, good action. Principle 4: Sadharana-bhogi, feature on humane society, mutual respect. Principle 5 Sila-samannata, feature on, follow the rules of society. Principle 5 Metta-manokamma feature on rationality, listening to the opinion of others. It found that there were process-driven learning and following six rules of saraniyadhamma, and immunity system, risk Decoupled. 3 Networks Saraniyadhamma learnt together with other

  4. Cortical areas involved in Arabic number reading.

    Science.gov (United States)

    Roux, F-E; Lubrano, V; Lauwers-Cances, V; Giussani, C; Démonet, J-F

    2008-01-15

    Distinct functional pathways for processing words and numbers have been hypothesized from the observation of dissociated impairments of these categories in brain-damaged patients. We aimed to identify the cortical areas involved in Arabic number reading process in patients operated on for various brain lesions. Direct cortical electrostimulation was prospectively used in 60 brain mappings. We used object naming and two reading tasks: alphabetic script (sentences and number words) and Arabic number reading. Cortical areas involved in Arabic number reading were identified according to location, type of interference, and distinctness from areas associated with other language tasks. Arabic number reading was sustained by small cortical areas, often extremely well localized (area (Brodmann area 45), the anterior part of the dominant supramarginal gyrus (Brodmann area 40; p area (Brodmann area 37; p areas.

  5. Plutonium focus area. Technology summary

    International Nuclear Information System (INIS)

    1997-09-01

    The Assistant Secretary for the Office of Environmental Management (EM) at the U.S. Department of Energy (DOE) chartered the Plutonium Focus Area (PFA) in October 1995. The PFA open-quotes...provides for peer and technical reviews of research and development in plutonium stabilization activities...close quotes In addition, the PFA identifies and develops relevant research and technology. The purpose of this document is to focus attention on the requirements used to develop research and technology for stabilization, storage, and preparation for disposition of nuclear materials. The PFA Technology Summary presents the approach the PFA uses to identify, recommend, and review research. It lists research requirements, research being conducted, and gaps where research is needed. It also summarizes research performed by the PFA in the traditional research summary format. This document encourages researchers and commercial enterprises to do business with PFA by submitting research proposals or open-quotes white papers.close quotes In addition, it suggests ways to increase the likelihood that PFA will recommend proposed research to the Nuclear Materials Stabilization Task Group (NMSTG) of DOE

  6. Cerrejon North Area, Environmental Administration

    International Nuclear Information System (INIS)

    Preteft Emiliani, Antonio

    1993-01-01

    The carboniferous complex of The Cerrejon North Area, it is located to the north of Colombia in the Atlantic coast, in the Guajira Department. The complex carboniferous has with three units: the mine, the railway and the shipment port. The associate companies, they have developed a series of plans to achieve that the ecosystem of the region like the life of the residents of the near towns to the carboniferous complex, don't be affected by the operation activities. From the beginning of the operations and according to the environmental impact study, was designed and it implanted a program of ecological protection with control actions and of monitory for the soil resources, water and air, of equal form, programs of social action were designed that allow that the realization of a work like this contributes benefits and non sacrifices to the human population, vegetable and animal of the region. The associates commit to make permanent efforts to improve the environmental acting in all the activities of their business, it will stimulate the respect and the concern for the environment, natural and social, and it will emphasize each employee's individual responsibility in the environmental acting

  7. Large-area photonic crystals

    Science.gov (United States)

    Ruhl, Tilmann; Spahn, Peter; Hellmann, Gotz P.; Winkler, Holger

    2004-09-01

    Materials with a periodically modulated refractive index, with periods on the scale of light wavelengths, are currently attracting much attention because of their unique optical properties which are caused by Bragg scattering of the visible light. In nature, 3d structures of this kind are found in the form of opals in which monodisperse silica spheres with submicron diameters form a face-centered-cubic (fcc) lattice. Artificial opals, with the same colloidal-crystalline fcc structure, have meanwhile been prepared by crystallizing spherical colloidal particles via sedimentation or drying of dispersions. In this report, colloidal crystalline films are introduced that were produced by a novel technique based on shear flow in the melts of specially designed submicroscopic silica-polymer core-shell hybrid spheres: when the melt of these spheres flows between the plates of a press, the spheres crystallize along the plates, layer by layer, and the silica cores assume the hexagonal order corresponding to the (111) plane of the fcc lattice. This process is fast and yields large-area films, thin or thick. To enhance the refractive index contrast in these films, the colloidal crystalline structure was inverted by etching out the silica cores with hydrofluoric acid. This type of an inverse opal, in which the fcc lattice is formed by mesopores, is referred to as a polymer-air photonic crystal.

  8. Sistem Rantai Pasok Pupuk Area

    Directory of Open Access Journals (Sweden)

    Harry Rahmadi Putra

    2011-10-01

    Full Text Available PT. Pupuk Kaltim is biggest manure manufacturer in Indonesia, where its market area covering entire Sulawesi, Bali, some of Kalimantan East Java, Papua, Japan, Taiwan, India, and Australia. Main produced product of PT Pupuk Kaltim is based fertilizer. To meet the demand, PT Kaltim produce up to 2,3 million tons per year.Identifiaction process of supply chain done by accesing company website of PT Kaltim. Then it is outlined each step of supply chain from aggregate planning, production process, suppliers selection, quality mangement, warehousing, performance measure and used transportation unit. From that criteria would visible supply chain of based-fertilizer in PT Pupuk Kaltim. By having long and wide supply chain, PT Pupuk Kaltim still have bullwhip effect because of inacurate in forecasting cause over-stock or out of stock in many production period. In quality, PT Kaltim had got ISO 9001, ISO 14001 and ISO 17025 certification in production management and sea-port. Keywords: Fertilizer, supply chain, analysis

  9. Disparities in the use of mobile phone for seeking childbirth services among women in the urban areas: Bangladesh Urban Health Survey.

    Science.gov (United States)

    Bishwajit, Ghose; Hoque, Md Rakibul; Yaya, Sanni

    2017-12-29

    In Bangladesh, similar to its other South Asian counterparts, shortage of health workers along with inadequate infrastructure constitute some of the major obstacles for the equitable provision of reproductive healthcare services, particularly among the marginalized and underserved neighbourhoods. However, given the rapidly expanding broadband communication and mobile phone market in the country, the application of eHealth and mHealth technologies offer a window of opportunities to minimise the impact of socioeconomic barriers and promote the utilization of maternal healthcare services thereby. In the present study we aimed to investigate 1) the prevalence of usage of mobile phones for seeking childbirth services, 2) neighbourhood and socioeconomic disparities in the use, and 3) association between using mobile phones and the uptake of postnatal care among mothers and neonates. Data for the present study came from Bangladesh Urban Health Survey 2013. Study subjects were 9014 married women aged between 15 and 49 years. The overall rate of use of mobile phone was highest in City Corporation non-Slum areas (16.2%) and lowest in City Corporation Slum areas (7.4%). The odds of using mobile for seeking childbirth services were significantly higher among those who were living in non-slum areas, and lower among those who never attended school and lived in poorer households. Results also indicated that women in the slum areas who used mobile phone for childbirth service seeking, were 4.3 times [OR = 4.250;95% CI = 1.856-9.734] more likely to receive postnatal care for themselves, and those from outside the city-corporation areas were 2.7 times [OR = 2.707;95% CI = 1.712-4.279] more likely to receive postnatal care for the newborn. Neighbourhood, educational and economic factors were significantly associated with the mobile phone utilization status among urban women. Promoting access to better education and sustainable income earning should be regarded as an

  10. China (country/area statements).

    Science.gov (United States)

    1985-09-01

    According to this statement presented to the Committee on Population of the UN Economic and Social Commission for Asia and the Pacific, China is similar to other countries in the region in that its rate of population growth has declined due to government family planning efforts while the absolute size of the population continues to increase because of the widening population base. However, China's enormous population of over 1 billion sets it apart and places great strain on economic development efforts. In the past decade the Chinese government has provided population education for the masses, explaining the relationship between population and socioeconomic development, and its overall family planning program has helped reduce population growth from 24.82/1000 in 1974 to 10.81/1000 in 1984. The net population increase has been over 100 million in the past 10 years, and if the present rate of increase with a total fertility rate of 2.1 is maintained for another 15 years, the total population would exceed 1.3 billion by 2000, posing a grave threat to China's socioeconomic development. The nucleus of China's population policy is its birth policy, whose main points are to promote family planning so that population growth will be in keeping with socioeconomic development and the utilization of natural resources and environmental protection. The policy is in line with the principles and objectives of the World Population Plan of Action adopted in 1974. The government has advocated the practice of "1 couple, 1 child" since 1979 to carry out the population policy and limit the total population to about 1.2 billion by the century's end. 28.17 million couples, 18.25% of the 150 million married couples of childbearing age, had received 1-child certificates by the end of 1984. Generally speaking, most couples in urban areas would be satisfied with 1 child, while those in rural areas usually prefer 2 children. The family planning program is carried out through publicity

  11. Vulnerability of intertropical littoral areas

    Science.gov (United States)

    Manighetti, Isabelle; De Wit, Rutger; Duvail, Stéphanie; Seyler, Patrick

    2017-10-01

    The coastal zone is of very high importance for human development and human wellbeing. Half of the global urban population lives in the coastal zone, where it has access to both continental and marine ecosystem services and to maritime transport. These urban populations coexist with rural and traditional coastal populations, some of which still possess good traditional ecological knowledge of the coastal ecosystems. Marine biodiversity and favourable environmental conditions sustain fisheries and aquaculture, represent a source of inspiration for humankind and provide numerous opportunities for recreation and tourism. In addition, coastal areas provide nursery functions for juvenile fish and invertebrates, which is important for the fish and crayfish stocks exploited offshore. Located at the interface between marine energy and continental processes, the coastal landscapes are dynamic environments. Nevertheless, the destruction of habitats and the increasing exploitation of the coastal zone represent serious threats to the ecosystems. Moreover, human land use and modifications in the watersheds have strong impacts on the coastal zone primarily by contributing to their pollution and nutrient over-enrichment. Damming and creation of reservoirs upstream also heavily modify the hydrology of the watersheds and often dramatically reduce the delivery of sediments to the coastal zone. In addition to these regional and local anthropogenic impacts, the coastal zone is vulnerable to global change among which sea level rise and climate change are particularly important drivers. Many coastal zones extend along giant faults and subduction zones, which makes them particularly exposed to earthquakes and tsunami hazards. Other forms of natural hazards are caused by hurricanes and cyclones that develop at sea and whose trajectories often hit the coastlines.

  12. The metro area of Montreal.

    Science.gov (United States)

    1986-10-01

    Montreal, one of the most civilized and cosmopolitan of North American cities, is the 2nd city in Canada in size and the largest French-speaking city. Of the 2.8 million people who lived there at census time in 1981, 45% chose both French and English as their official language, 41% chose French, and 1% used some other language. Fully 68% of Montreal residents said their mother tongue was French, and 68% also said they spoke French at home. The importance of bilingualism to the business culture of Montreal cannot be overemphasized. In the last decade, French-Canadians have taken an increasingly stronger role in business. Upper-middle-class suburbs that as little as 10 years ago had only 10% of their residents who were of French-Canadian descent now have as many as 50-60% of their residents who are French-Canadians. Most residents of Montreal willingly learn 2 languages. US firms should assume that all representatives who are sent to Montreal should be fluent in both French and English. Montreal's 2,828,349 people create a population density of 1004.9 persons per square kilometer. Montreal has 665 census tracts, which are described in the Metropolitan Atlas Series. Nearly 62% of Montreal's population fall between the ages of 20 and 64--the prime working ages. Although Montreal is 79% Catholic, it does not have the high fertility levels often associated with Catholic areas. There were 1,026,920 households in Montreal in 1981 with an average of 2.7 persons per household. 71% of these were census family households. Montreal had 1,026,895 occupied dwellings in 1985 with an average of 5 rooms each. About 71% of the population aged 15 and over that were not in school were in the labor force; 41% of the labor force was female. The largest employment category for men was manufacturing (16%) and the largest for women was clerical work (39%).

  13. Transfer Area Mechanical Handling Calculation

    International Nuclear Information System (INIS)

    Dianda, B.

    2004-01-01

    This calculation is intended to support the License Application (LA) submittal of December 2004, in accordance with the directive given by DOE correspondence received on the 27th of January 2004 entitled: ''Authorization for Bechtel SAX Company L.L. C. to Include a Bare Fuel Handling Facility and Increased Aging Capacity in the License Application, Contract Number DE-AC--28-01R W12101'' (Arthur, W.J., I11 2004). This correspondence was appended by further Correspondence received on the 19th of February 2004 entitled: ''Technical Direction to Bechtel SAIC Company L.L. C. for Surface Facility Improvements, Contract Number DE-AC--28-OIRW12101; TDL No. 04-024'' (BSC 2004a). These documents give the authorization for a Fuel Handling Facility to be included in the baseline. The purpose of this calculation is to establish preliminary bounding equipment envelopes and weights for the Fuel Handling Facility (FHF) transfer areas equipment. This calculation provides preliminary information only to support development of facility layouts and preliminary load calculations. The limitations of this preliminary calculation lie within the assumptions of section 5 , as this calculation is part of an evolutionary design process. It is intended that this calculation is superseded as the design advances to reflect information necessary to support License Application. The design choices outlined within this calculation represent a demonstration of feasibility and may or may not be included in the completed design. This calculation provides preliminary weight, dimensional envelope, and equipment position in building for the purposes of defining interface variables. This calculation identifies and sizes major equipment and assemblies that dictate overall equipment dimensions and facility interfaces. Sizing of components is based on the selection of commercially available products, where applicable. This is not a specific recommendation for the future use of these components or their

  14. Philippines (country/area statements).

    Science.gov (United States)

    1985-09-01

    According to this statement presented to the Committee on Population of the UN Economic and Social Commission for Asia and the Pacific, the 1980 Philippine census enumerated 48.1 million persons, a more than 6-fold increase over the 7.6 million of 1903. The 1913-39 average intercensal growth rate of 2.22% declined during World War II but soared to 3.06% from 1948-60. The growth rate was 2.71% between 1975-80. The median age was 20.2 in 1903, 16.9 in 1970 and 18.6 in 1980. The crude birth rate declined from 46.0/1000 in 1960 to 34.8 in 1975, while the crude death rate declined from 13.7/1000 in 1960 to 9.3 in 1975. The average age of Filipino women at marriage increased from 23.2 in 1975 to 24 in 1978, causing a decline of the total fertility rate from 5.89 to 4.70. The infant mortality rate was expected to decline from 59.3 in 1983 to 54.2 in 1987. The Philippines was still 63% rural in 1980 despite the concentration of urban growth in Manila. As of 1983, the Philippine Overseas Employment Administration had processed 434,207 employment contracts, of which 65.5% were for production process workers, transport equipment operators, and laborers, 15.3% were for service workers, and 13.9% were for professional and technical workers. The Philippine Family Planning program aims to reduce population growth from an estimated 2.54% in 1983 to 1.92% by 1993 and to achieve replacement level fertility by 2010. As a result of the 1978 review of the Philippine Population Programme, the focus is now on longterm planning to ensure more significant and perceptible demographic impact of development programs and policies. The Population Education Program aims to inculcate values supporting family planning in the areas of family size and welfare, responsible parenthood, and delayed marriage, while the Adolescent Fertility Program seeks to reduce the incidence of early marriage and pregnancy. 3496 clinics, hospitals, and sterilization centers provide family planning and related services

  15. Sustainable Rest Area Design and Operations

    Science.gov (United States)

    2017-10-01

    One way in which State Departments of Transportation (DOTs) can modernize their rest areas while reducing operations and maintenance costs is by incorporating sustainable practices into rest area design and operations. Sustainability practices that D...

  16. West Coast Rockfish Conservation Areas, 2015

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — These data delineate Rockfish Conservation Areas (RCA) off the West Coast of the United States for 2015. There are three types of areas closures depicted in this...

  17. Mandatory Class 1 Federal Areas Web Service

    Data.gov (United States)

    U.S. Environmental Protection Agency — This web service contains the following layers: Mandatory Class 1 Federal Area polygons and Mandatory Class 1 Federal Area labels in the United States. The polygon...

  18. Science and Technology Business Area Strategic Plan

    National Research Council Canada - National Science Library

    Paul, Richard

    2000-01-01

    The S&T Business Area Strategic Plan has been updated to include lessons learned over the last two years, identifies areas that need to be reviewed further, addresses business opportunities and threats...

  19. Bureau of Land Management Wilderness Areas

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This dataset is meant to depict wilderness areas within the state of New Mexico managed by the Bureau of Land Management These wilderness areas are officially...

  20. AgSat Areas of Interest

    Data.gov (United States)

    Farm Service Agency, Department of Agriculture — The AgSat Areas of Interest map contains area polygons where satellite imagery will be collected for the Farm Service Agency (FSA) to provide imagery coverage for...