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

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

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

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

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

Beliefs and attitudes regarding drug treatment: Application of the Theory of Planned Behavior in African-American cocaine users

The Theory of Planned Behavior (TPB) can provide insights into perceived need for cocaine treatment among African American cocaine users

A randomized controlled trial testing the efficacy of a brief cannabis universal prevention program among adolescents in primary care

Aims To examine the efficacy of a brief intervention delivered by a therapist ( TBI ) or a computer ( CBI ) in preventing cannabis use among adolescents in urban primary care clinics. Design A randomized controlled trial comparing: CBI and TBI versus control. Setting Urban primary care clinics in the U nited S tates. Participants Research staff recruited 714 adolescents (aged 12–18 years) who reported no life‐time cannabis use on a screening survey for this study, which included a baseline survey, randomization (stratified by gender and grade) to conditions (control; CBI ; TBI ) and 3‐, 6‐ and 12‐month assessments. Measurements Using an intent‐to‐treat approach, primary outcomes were cannabis use (any, frequency); secondary outcomes included frequency of other drug use, severity of alcohol use and frequency of delinquency (among 85% completing follow‐ups). Findings Compared with controls, CBI participants had significantly lower rates of any cannabis use over 12 months (24.16%, 16.82%, respectively, P  < 0.05), frequency of cannabis use at 3 and 6 months ( P  < 0.05) and other drug use at 3 months ( P  < 0.01). Compared with controls, TBI participants did not differ in cannabis use or frequency, but had significantly less other drug use at 3 months ( P  < 0.05), alcohol use at 6 months ( P  < 0.01) and delinquency at 3 months ( P  < 0.01). Conclusions Among adolescents in urban primary care in the U nited S tates, a computer brief intervention appeared to prevent and reduce cannabis use. Both computer and therapist delivered brief interventions appeared to have small effects in reducing other risk behaviors, but these dissipated over time.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106949/1/add12469.pd

The REASONS Survey : resolved millimeter observations of a large debris disk around the nearby F Star HD 170773

Debris disks are extrasolar analogs to our own Kuiper Belt and they are detected around at least 17% of nearby Sun-like stars. The morphology and dynamics of a disk encode information about its history, as well as that of any exoplanets within the system. We used the Atacama Large Millimeter/submillimeter Array (ALMA) to obtain 1.3 mm observations of the debris disk around the nearby F5V star HD 170773. We image the face-on ring and determine its fundamental parameters by forward-modeling the interferometric visibilities through a Markov Chain Monte Carlo approach. Using a symmetric Gaussian surface density profile, we find a 71 ± 4 au wide belt with a radius of {193}-3+2 au, a relatively large radius compared with most other millimeter-resolved belts around late A/early F type stars. This makes HD 170773 part of a group of four disks around A and F stars with radii larger than expected from the recently reported planetesimal belt radius—stellar luminosity relation. Two of these systems are known to host directly imaged giant planets, which may point to a connection between large belts and the presence of long-period giant planets. We also set upper limits on the presence of CO and CN gas in the system, which imply that the exocomets that constitute this belt have CO and HCN ice mass fractions of <77% and <3%, respectively. This is consistent with solar system comets and other exocometary belts

Association between anxiety disorders and heart rate variability in The Netherlands Study of Depression and Anxiety (NESDA)

Objective: To determine whether patients with different types of anxiety disorder (panic disorder, social phobia, generalized anxiety disorder) have higher heart rate and lower heart rate variability compared with healthy controls in a sample that was sufficiently powered to examine the confounding effects of lifestyle and antidepressants. Methods: The standard deviation of the normal-to-normal intervals (SDNN), heart rate (HR), and respiratory sinus arrhythmia (RSA) were measured in 2059 subjects (mean age = 41.7 years, 66.8% female) participating in The Netherlands Study of Depression and Anxiety (NESDA). Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and Composite International Diagnostic Interview (CIDI), NESDA participants were classified as healthy controls (n = 616), subjects with an anxiety diagnosis earlier in life (n = 420), and Subjects with current anxiety diagnosis (n = 1059). Results: Current anxious Subjects had a significantly lower SDNN and RSA compared with controls. RSA was also significantly lower in remitted anxious subjects compared with controls. These associations were similar across the three different types of anxiety disorders. Adjustment for lifestyle had little impact. However, additional adjustment for antidepressant use reduced all significant associations between anxiety and HRV to nonsignificant. Anxious subjects who used a tricyclic antidepressant, it selective serotonin reuptake inhibitor, or another antidepressant showed significantly lower mean SDNN and RSA compared with controls (effect sizes = 0.20-0.80 for SDNN and 0.42-0.79 for RSA). Nonmedicated anxious subjects did not differ from controls in mean SDNN and RSA. Conclusion: This study shows that anxiety disorders are associated with significantly lower HR variability, but the association seems to be driven by the effects of antidepressants