Practice transformations to optimize the delivery of HIV primary care in community healthcare settings in the United States: A program implementation study.

BackgroundThe United States HIV care workforce is shrinking, which could complicate service delivery to people living with HIV (PLWH). In this study, we examined the impact of practice transformations, defined as efficiencies in structures and delivery of care, on demonstration project sites within the Workforce Capacity Building Initiative, a Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program Special Projects of National Significance (SPNS).Methods and findingsData were collected at 14 demonstration project sites in 7 states and the District of Columbia. Organizational assessments were completed at sites once before and 4 times after implementation. They captured 3 transformation approaches: maximizing the HIV care workforce (efforts to increase the number of existing healthcare workforce members involved in the care of PLWH), share-the-care (team-based care giving more responsibility to midlevel providers and staff), and enhancing client engagement in primary HIV care to reduce emergency and inpatient care (e.g., care coordination). We also obtained Ryan White HIV/AIDS Program Services Reports (RSRs) from sites for calendar years (CYs) 2014-2016, corresponding to before, during, and after transformation. The RSR include data on client retention in HIV care, prescription of antiretroviral therapy (ART), and viral suppression. We used generalized estimating equation (GEE) models to analyze changes among sites implementing each practice transformation approach. The demonstration projects had a mean of 18.5 prescribing providers (SD = 23.5). They reported data on more than 13,500 clients per year (mean = 969/site, SD = 1,351). Demographic characteristics remained similar over time. In 2014, a majority of clients were male (71% versus 28% female and 0.2% transgender), with a mean age of 47 (interquartile range [IQR] 37-54). Racial/ethnic characteristics (48% African American, 31% Hispanic/Latino, 14% white) and HIV risk varied (31% men who have sex with men; 31% heterosexual men and women; 7% injection drug use). A substantial minority was on Medicaid (41%). Across sites, there was significant uptake in practices consistent with maximizing the HIV care workforce (18% increase, p < 0.001), share-the-care (25% increase, p < 0.001), and facilitating patient engagement in HIV primary care (13% increase, p < 0.001). There were also significant improvements over time in retention in HIV care (adjusted odds ratio [aOR] = 1.03; 95% confidence interval [CI] 1.02-1.04; p < 0.001), ART prescription levels (aOR = 1.01; 95% CI 1.00-1.01; p < 0.001), and viral suppression (aOR = 1.03; 95% CI 1.02-1.04; p < 0.001). All outcomes improved at sites that implemented transformations to maximize the HIV care workforce or improve client engagement. At sites that implemented share-the-care practices, only retention in care and viral suppression outcomes improved. Study limitations included use of demonstration project sites funded by the Ryan White HIV/AIDS Program (RWHAP), which tend to have better HIV outcomes than other US clinics; varying practice transformation designs; lack of a true control condition; and a potential Hawthorne effect because site teams were aware of the evaluation.ConclusionsIn this study, we found that practice transformations are a potential strategy for addressing anticipated workforce challenges among those providing care to PLWH. They hold the promise of optimizing the use of personnel and ensuring the delivery of care to all in need while potentially enhancing HIV care continuum outcomes

A procedure for developing an acceptance test for airborne bathymetric lidar data application to NOAA charts in shallow waters

National Oceanic and Atmospheric Administration (NOAA) hydrographic data is typically acquired using sonar systems, with a small percent acquired via airborne lidar bathymetry for near‐shore areas. This study investigated an integrated approach for meeting NOAA’s hydrographic survey requirements for near‐shore areas of NOAA charts, using the existing topographic‐bathymetric lidar data from USACE’s National Coastal Mapping Program (NCMP). Because these existing NCMP bathymetric lidar datasets were not collected to NOAA hydrographic surveying standards, it is unclear if, and under what circumstances, they might aid in meeting certain hydrographic surveying requirements. The NCMP’s bathymetric lidar data are evaluated through a comparison to NOAA’s Office of Coast Survey hydrographic data derived from acoustic surveys. As a result, it is possible to assess if NCMP’s bathymetry can be used to fill in the data gap shoreward of the navigable area limit line (0 to 4 meters) and if there is potential for applying NCMP’s bathymetry lidar data to near‐shore areas deeper than 10 meters. Based on the study results, recommendations will be provided to NOAA for the site conditions where this data will provide the most benefit. Additionally, this analysis may allow the development of future operating procedures and workflows using other topographic‐ bathymetric lidar datasets to help update near‐shore areas of the NOAA charts

Science Writers' Guide to Terra

This guide was produced for science writers and the media and provides research profiles, as well as extensive background and contact information for NASA’s Terra spacecraft. Terra’s launch marked a new era of comprehensive monitoring of the Earth's atmosphere, oceans and continents from a single space-based platform. Data from the five Terra instruments are creating continuous, long-term records of the state of the land, oceans and atmosphere. Together with data from other satellite systems launched by NASA and other countries, Terra will inaugurate a new self-consistent data record that will be gathered over the next 15 years. Educational levels: Informal education

Working Notes from the 1992 AAAI Workshop on Automating Software Design. Theme: Domain Specific Software Design

The goal of this workshop is to identify different architectural approaches to building domain-specific software design systems and to explore issues unique to domain-specific (vs. general-purpose) software design. Some general issues that cut across the particular software design domain include: (1) knowledge representation, acquisition, and maintenance; (2) specialized software design techniques; and (3) user interaction and user interface

Urban Simulation Models: Contributions as Analysis-Methodology in a Project of Urban Renewal

The recent urban transformations produced in cities indicate the need to propose new theoretical and methodological approaches in physical planning. Based on the idea of complexity, it is required to integrate, in the analysis, multiplicity of interrelated factors involved in urban development,moreover, to develop planning tools that can incorporate variables not initially considered (for example when the norms were sanctioned) and instruments that would provide assessment alternatives to planning decisions in real time. The simulation models are suggested as tools to detect the elements, relationships and the dynamics in a simplified form that allow experiencing on the results. That is to say, a theoretical position on to a computer model is translated to investigate (in an experimental way) possible solutions derived from manipulating the variables, before the phenomenon is materialized. In the case of urban planning, this condition is of particular relevance, given the importance to anticipate unwanted effects in the intervention context that may arise when urban projects are built. The paper evaluates the application of a simulation methodology,based on the dynamics of systems and the application of software that can anticipate the effects of certain decisions in an urban renewal project in the city of Córdoba, Argentina. It applies the General Systems Theory that is a contribution to the notion of complex thought and is trans-disciplinary. Based on the idea of complex and multidimensional city, the effects of a real estate development are analyzed and conclusions on the limits and possibilities of using this tool during the processes of urban management are provided.Fil: Marengo, Maria Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Córdoba. Facultad de Arquitectura, Urbanismo y Diseño. Instituto de Investigación de la Vivienda; Argentin

Social Entrepreneurship and Social Transformation

This study provides a comparative analysis of seven cases of social entrepreneurship that have been widely recognized as successful. The paper suggests factors associated with successful social entrepreneurship, particularly with social entrepreneurship that leads to significant changes in the social, political and economic contexts for poor and marginalized groups. It generates hypotheses about core innovations, leadership, organization, and scaling up in successful social entrepreneurship. The paper concludes with a discussion of the implications for the practice of social entrepreneurship, for further research, and for the continued development of support technologies and institutions that will encourage future social entrepreneurship.This publication is Hauser Center Working Paper No. 15. The Hauser Center Working Paper Series was launched during the summer of 2000. The Series enables the Hauser Center to share with a broad audience important works-in-progress written by Hauser Center scholars and researchers

Gender Impact Strategy for Agricultural Development

Argues for addressing gender equality issues in agricultural development projects. Outlines required components for future grants, including women's optimum participation, efforts to increase income-generating opportunities, and monitoring and evaluation