Clinical reconciliation of patient social context and implementation of preventive care guidelines

Background Preventive care practice guidelines are disseminated regularly through federal and scientific groups as a way of promoting best practices and evidence-based health promotion. Yet rates of their implementation are historically low and complex, with cited barriers including limits on physicians’ time, knowledge or attitudes; and external factors related to the guideline itself, the clinical environment, or patient factors. The objective of this qualitative research is to understand how primary care clinicians and staff reconcile perceived patient-level factors and implementation of preventive care guidelines. Methods Key informant interviews (n=23) with 14 clinicians and 9 office managers from 14 primary care clinics were analyzed using a grounded theory approach. Codes were categorized, then reviewed using conventional content analysis to determine thematic content. Results The importance of using communication tools; convenience for access to preventive services; and weighing the evidence when deciding how to proceed with preventive care emerged as themes related to understanding how providers reconcile between patient factors and implementation of preventive care guidelines. Conclusions The interviews used in this study provide some rich context to address the research objective: how providers reconcile between what they perceive to be patient factors and how they go about providing preventive care according to guidelines. The hope for this study is to identify key themes to instigate future exploratory research and provide evidence to target improvements in patient care.https://scholarscompass.vcu.edu/gradposters/1051/thumbnail.jp

Their Sleep Is To Be Desecrated : California\u27s Central Valley Project and the Wintu People of Northern California, 1938- 1943

The morning of July 14, 1944, was intended to be a moment of celebration for the City of Redding, California. Secretary of the Interior Harold L. Ickes had been scheduled to arrive in the booming city to dedicate Shasta Dam, a national reclamation project of great pride to local citizens and construction workers. Just days prior, however, the dedication ceremony had been canceled due to the inability of Ickes to leave Washington D.C.. Instead, a small group of U.S. Bureau of Reclamation (BOR) officials, Sacramento Municipal Utility District (SMUD) officials, and local city officials quietly gathered within the dam\u27s $19,400,000 power plant. A BOR official flipped a switch to start one of the plant\u27s two massive generators, sending a surge of 120,000 watts of hydroelectricity into California\u27s transmission lines and the Pacific, Gas, and Electric (PG&E) distribution system. This energy would fuel the West\u27s war industries and the federal defense effort in World War II. Though without fanfare, the switching event signaled the official start of commercial production of power from the world\u27s second largest dam and keystone of the Central Valley Project (CVP). From Washington, D.C., the event was heralded by BOR Commissioner Harry W. Bashore as a milestone in the fulfillment of visions Californians have had for nearly 100 years.

Corporate Support for Employee Health Insurance for Franchises and Company Owned National Chains

Discusses the decline of employer-based health insurance, various options for employers, and the debate over legislation to strengthen employer-based coverage. Gives examples of innovative ways in which some businesses provide employee health insurance

Structural Design Guidelines for Pervious Concrete Pavements

Pervious pavements have gained popularity in recent years as the transportation industry focuses on sustainability and environmental impact. This research investigated the structural design of pervious concrete pavements. There is no standard design method; therefore, the goal was to lessen ambiguity surrounding the use of pervious concrete for pavement structures. By characterization of the rigid pavement design equation from the 1993 AASHTO Structural Design Guide for Design of Pavement Structures through laboratory exploration and review of existing literature, a guide was created to assist engineers in the design of pervious concrete pavements

Ambient Air Toxic Releases and Adverse Pregnancy Outcomes in Allegheny County, Pennsylvania

Previous studies have shown that women exposed to certain air pollutants are at an increased risk for preterm delivery and/or delivering a low birth weight newborn. Preterm delivery and low birth weight are associated with an increased risk for morbidity and mortality. In an effort to better understand the impact of local environmental factors on pregnancy health, duration and outcomes, this study investigated the relationship of hazardous air pollutant chemicals released by local industries and the adverse pregnancy outcomes of preterm delivery and term low birth weight in Allegheny County, PA.This study included 2,798 singleton birth records for deliveries that occurred in Allegheny County in January through March of 2004. The Toxic Release Inventory provided data for 2003 fugitive and stack air releases of all facilities in Allegheny County reporting air releases of lead and toluene. This data was used for determining proxy maternal exposure measurements. ArcGIS software was used to calculate the distance from each maternal residence to each TRI facility. The distances and reported total pounds of release from each facility were then used to calculate a total lead and toluene exposure value for every birth record. Binary logistic regression was used to assess maternal characteristics' effects on birth outcomes. Chi square tests were used to assess maternal characteristics and levels of exposure to lead and toluene. Chi square tests and binary logistic regression were then used to assess pregnancy outcomes in relation to quartiles of exposure.This study found that mothers with certain age, race, education, and marital characteristics were significantly associated with lower exposure levels of lead and toluene. However, exposure to higher levels of lead or toluene, as measured in this study, was not significantly associated with an increased risk for preterm delivery or term low birth weight.Adverse pregnancy outcomes negatively impact an individual's immediate and lifelong health. Decreasing the incidence of preterm delivery and low birth weight are of great importance to public health. Research that helps to identify environmental determinants of adverse pregnancy outcomes is of vital public health significance

Quantifying the Lock-In Effect in a Dynamic Industry

No abstract.

Moving TANF Recipients with Disabilities to Work: Examples of State Strategies

The brief examines activities in place to help move receipients of Temporary Assistance for Needy Families (TANF) who have a disability to employment. It looks at the opportunities and challenges to state governments in crafting supports and services, as well as offers a glimpse of some strategies and approaches being used by state TANF agencies to help recipients with a disability secure and maintain employment

Offering the Choice of Self-Administered Oral HIV Testing (CHIVST) among Long-distance Truck Drivers in Kenya: A Trial-based Cost-effectiveness Analysis

Background: Long distance truck drivers (LDTD) are a high-HIV-risk population facing unique healthcare barriers due to continuous travel and irregular schedules, and may require targeted, resource-intensive strategies for HIV-test uptake. We conducted a trial-based cost-effectiveness of CHIVST among LDTD in Kenya. Methods: Effectiveness data came from a randomized-controlled trial of CHIVST (n=150) versus provider-administered testing (n=155). Economic cost data came from the literature and reflected a societal perspective. Generalized Poisson and linear-gamma regression models estimated the effectiveness (relative-risk) and incremental costs (2017 I$), respectively, with incremental effectiveness calculated as the reciprocal of the absolute risk difference and reported as the number needing to receive CHIVST for an additional HIV-test uptake. We reported incremental cost-effectiveness ratios (ICERs), with 95$9,774). Results: HIV-test uptake was 23% more likely for CHIVST versus provider-administered HIVtesting, with six individuals needing to be offered CHIVST for an additional HIV-test uptake (6.25, 95%CI 5.00-8.33). The mean cost per patient was more than double for CHIVST (I$26.56 vs I$10.47). The incremental cost-effectiveness of CHIVST was I$97.21 [95$140. Conclusion: CHIVST is an efficient use of resources compared to provider-administered testing.https://scholarscompass.vcu.edu/gradposters/1114/thumbnail.jp

Strategies to Increase Food Stamp Participation

Discusses the benefits, for both individuals and states, of boosting participation in food and nutrition programs. Recommends strategies and best practices to expand participation while lowering costs, such as coordinating efforts with other programs

Seeking out non-public information : sell-side analysts and the freedom of information act

A number of sell-side healthcare analysts gain access to information outside the purview of management through Freedom of Information Act requests to the Food and Drug Administration for records on factory inspections, complaints, and drug and medical device applications. Using a difference-in-differences methodology, we find that buy (sell) recommendations and upgrades (downgrades) earn higher (lower) stock returns over the year following the receipt of FDA records. We also examine the type of information revealed in FDA factory inspection reports, and find that analysts are less likely to downgrade and are less pessimistic in their recommendations than the consensus recommendation when the information contained in the FDA report is not particularly severe. Our findings are consistent with a subset of analysts utilizing non-public information channels independent of management to gain value-relevant information about their covered firms