Using the QI Maturity Tool to Classify Agencies Along a Continuum

Major investments have been made to encourage health departments to implement quality improvement (QI) efforts. Yet, there are few empirically tested tools for public health agencies that assess these efforts and classify health departments along a QI continuum. This paper presents a new classification scheme for measuring QI Maturity in public health agencies based on a validated tool. The findings can be used to establish benchmarks, make comparisons and conduct future research linking QI and population health outcomes

Resolved Imaging of the HR 8799 Debris Disk with Herschel

We present Herschel far-infrared and submillimeter maps of the debris disk associated with the HR 8799 planetary system. We resolve the outer disk emission at 70, 100, 160 and 250 um and detect the disk at 350 and 500 um. A smooth model explains the observed disk emission well. We observe no obvious clumps or asymmetries associated with the trapping of planetesimals that is a potential consequence of planetary migration in the system. We estimate that the disk eccentricity must be <0.1. As in previous work by Su et al. (2009), we find a disk with three components: a warm inner component and two outer components, a planetesimal belt extending from 100 - 310 AU, with some flexibility (+/- 10 AU) on the inner edge, and the external halo which extends to ~2000 AU. We measure the disk inclination to be 26 +/- 3 deg from face-on at a position angle of 64 deg E of N, establishing that the disk is coplanar with the star and planets. The SED of the disk is well fit by blackbody grains whose semi-major axes lie within the planetesimal belt, suggesting an absence of small grains. The wavelength at which the spectrum steepens from blackbody, 47 +/- 30 um, however, is short compared to other A star debris disks, suggesting that there are atypically small grains likely populating the halo. The PACS longer wavelength data yield a lower disk color temperature than do MIPS data (24 and 70 um), implying two distinct halo dust grain populations.Comment: 13 pages, 8 figures (6 color), accepted for publication in the Astrophysical Journa

Longitudinal Health Outcomes and Treatment Utilization Among Emerging, Early-Mid, and Older Rural Adults Using Stimulants

There is limited knowledge about age-related differences in health outcomes and treatment utilization among rural stimulant users. The current study examined physical health, mental health, and treatment utilization (hospital, mental health, and substance use care) among 710 stimulant users living in rural areas of the United States. Generalized estimating equations (GEE) were used to examine associations between age and physical health, mental health, and treatment utilization over a 3-year period. Analyses controlled for participants’ gender, race, and education. To capture age-related differences, participants were grouped into emerging adults (18–25 years old, n = 223), early-mid adults (26–44 years old; n = 384), and older adults (45–61 years old; n = 103). At baseline, older stimulant users were in significantly poorer health even though they had significantly fewer substance use problems than emerging adult users. GEE models indicated that substance use outcomes improved for all participants over the course of the study but other outcomes remained stable. Older stimulant users continued to have worse physical health and mental health, even though they had fewer substance use problems, than the other age groups. Older adults also used more hospital and mental health services than the other age groups. White participants tended to be at higher risk for negative outcomes than nonwhite participants. We conclude that rural older adults who use stimulants have poor health despite having milder substance use problems and using more health care resources, and need targeted intervention to improve health outcomes

Far-infrared and sub-millimetre imaging of HD 76582's circumstellar disc

Debris discs, the tenuous rocky and icy remnants of planet formation, are believed to be evidence for planetary systems around other stars. The JCMT/SCUBA-2 debris disc legacy survey ‘SCUBA-2 Observations of Nearby Stars’ (SONS) observed 100 nearby stars, amongst them HD 76582, for evidence of such material. Here, we present imaging observations by JCMT/SCUBA-2 and Herschel/PACS at sub-millimetre and far-infrared wavelengths, respectively. We simultaneously model the ensemble of photometric and imaging data, spanning optical to sub-millimetre wavelengths, in a self-consistent manner. At far-infrared wavelengths, we find extended emission from the circumstellar disc providing a strong constraint on the dust spatial location in the outer system, although the angular resolution is too poor to constrain the interior of the system. In the sub-millimetre, photometry at 450 and 850 µm reveals a steep fall-off that we interpret as a disc dominated by moderately sized dust grains (amin = 36 µm), perhaps indicative of a non-steady-state collisional cascade within the disc. A disc architecture of three distinct annuli, comprising an unresolved component at 20 au and outer components at 80 and 270 au, along with a very steep particle size distribution (γ = 5), is proposed to match the observations

Acceptability of HIV Testing Sites Among Rural and Urban African Americans Who Use Cocaine

African Americans (AAs) who use cocaine in the Southern region of the U.S. have a relatively high risk of HIV and need for HIV testing. Among this group, those residing in rural areas may have less favorable opinions about common HIV testing sites, which could inhibit HIV testing. We examined rural/urban variations in their acceptability of multiple HIV testing sites (private physician clinic, local health department, community health center, community HIV fair, hospital emergency department, blood plasma donation center, drug abuse treatment facility, and mobile van or community outreach worker). Results from partial proportional odds and logistic regression analyses indicate that rural AA who use cocaine have lower odds of viewing local health departments (OR = 0.09, 95 % CI = 0.03–0.21), physician offices (OR = 0.19, 95 % CI = 0.09–0.42), and drug use treatment centers (OR = 0.49; 95 % CI = 0.30–0.80) as acceptable relative to their urban counterparts. The findings have implications for further targeting HIV testing toward AAs who use of cocaine, particularly those residing in the rural South

Resolved Debris Discs Around A Stars in the Herschel DEBRIS Survey

The majority of debris discs discovered so far have only been detected through infrared excess emission above stellar photospheres. While disc properties can be inferred from unresolved photometry alone under various assumptions for the physical properties of dust grains, there is a degeneracy between disc radius and dust temperature that depends on the grain size distribution and optical properties. By resolving the disc we can measure the actual location of the dust. The launch of Herschel, with an angular resolution superior to previous far-infrared telescopes, allows us to spatially resolve more discs and locate the dust directly. Here we present the nine resolved discs around A stars between 20 and 40 pc observed by the DEBRIS survey. We use these data to investigate the disc radii by fitting narrow ring models to images at 70, 100 and 160 {\mu}m and by fitting blackbodies to full spectral energy distributions. We do this with the aim of finding an improved way of estimating disc radii for unresolved systems. The ratio between the resolved and blackbody radii varies between 1 and 2.5. This ratio is inversely correlated with luminosity and any remaining discrepancies are most likely explained by differences to the minimum size of grain in the size distribution or differences in composition. We find that three of the systems are well fit by a narrow ring, two systems are borderline cases and the other four likely require wider or multiple rings to fully explain the observations, reflecting the diversity of planetary systems.Comment: 19 pages, 13 figures, 6 tables. Accepted for publication in MNRA

ALMA 1.3 Millimeter Map of the HD 95086 System

Planets and minor bodies such as asteroids, Kuiper-belt objects and comets are integral components of a planetary system. Interactions among them leave clues about the formation process of a planetary system. The signature of such interactions is most prominent through observations of its debris disk at millimeter wavelengths where emission is dominated by the population of large grains that stay close to their parent bodies. Here we present ALMA 1.3 mm observations of HD 95086, a young early-type star that hosts a directly imaged giant planet b and a massive debris disk with both asteroid- and Kuiper-belt analogs. The location of the Kuiper-belt analog is resolved for the first time. The system can be depicted as a broad ($\Delta R/R \sim$0.84), inclined (30\arcdeg$\pm$3\arcdeg) ring with millimeter emission peaked at 200$\pm$6 au from the star. The 1.3 mm disk emission is consistent with a broad disk with sharp boundaries from 106$\pm$6 to 320$\pm$20 au with a surface density distribution described by a power law with an index of --0.5$\pm$0.2. Our deep ALMA map also reveals a bright source located near the edge of the ring, whose brightness at 1.3 mm and potential spectral energy distribution are consistent with it being a luminous star-forming galaxy at high redshift. We set constraints on the orbital properties of planet b assuming co-planarity with the observed disk.Comment: accepted for publication in A

The debris disk around gamma Doradus resolved with Herschel

We present observations of the debris disk around gamma Doradus, an F1V star, from the Herschel Key Programme DEBRIS (Disc Emission via Bias-free Reconnaissance in the Infrared/Submillimetre). The disk is well-resolved at 70, 100 and 160 micron, resolved along its major axis at 250 micron, detected but not resolved at 350 micron, and confused with a background source at 500 micron. It is one of our best resolved targets and we find it to have a radially broad dust distribution. The modelling of the resolved images cannot distinguish between two configurations: an arrangement of a warm inner ring at several AU (best-fit 4 AU) and a cool outer belt extending from ~55 to 400 AU or an arrangement of two cool, narrow rings at ~70 AU and ~190 AU. This suggests that any configuration between these two is also possible. Both models have a total fractional luminosity of ~10^{-5} and are consistent with the disk being aligned with the stellar equator. The inner edge of either possible configuration suggests that the most likely region to find planets in this system would be within ~55 AU of the star. A transient event is not needed to explain the warm dust's fractional luminosity.Comment: 12 pages, 6 figures, accepted for publication in Ap

Characteristics of Cocaine Users Presenting to an Emergency Department Chest Pain Observation Unit

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73770/1/j.aem.2004.11.021.pd