Patient Perspectives of the Doctor-at-Home Service

Introduction. Home health care has been established as an effective model for reducing mortality in the elderly. The Doctor-at-Home Service at the Community Health Centers of Burlington (CHCB) has offered home health care to Burlington residents since January 2015. Dr. Karen Sokol, MD, alone provides care to 176 patients at their homes, including at-home palliative care. CHCB hope to expand this program by hiring more providers. Objective. To understand the impact of the Doctor-at-Home Service from the pa- tients’ perspective. Methods. A survey was administered to a cohort of eighteen patients over an 8- week period and addressed topics such as barriers to healthcare, benefits, and costs associated with doctor-at-home programs. A theme analysis on the responses was then conducted to reflect patient opinions. Available summary data describing the pa- tient population was also analyzed. Results. The Doctor- at- Home program serves patients ranging from 26 to 100 years old, with the majority of the patient population comprised of senior citizens. Prior to at home care, patients faced barriers such as lack of transportation, negative past experi- ences, anxiety, and distance from relatives. Four main themes from patient responses were physician-patient relationship, convenience, quality of care, and environment of care. Discussion. Evidence is compelling that there is a desire and need for an exten- sion of the Doctor-at-Home program to reach additional patients. Doctor-at-Home pro- grams could eliminate identified barriers and provide quality care to patients, especially those with specific barriers to access.https://scholarworks.uvm.edu/comphp_gallery/1256/thumbnail.jp

A Case of Beare-Stevenson Syndrome with Unusual Manifestations

Case series Patient: - Final Diagnosis: Beare-Stevenson syndrome Symptoms: - Medication: - Clinical Procedure: Genetic analysis Specialty: Pediatrics and Neonatology Objective: Rare disease Background: Beare-Stevenson syndrome (BSS) is an extremely rare genetic disorder, with fewer than 25 cases reported worldwide. This autosomal dominant syndrome has been linked to two mutations in the fibroblast growth factor receptor 2 gene (FGFR2), Tyr375Cys and Ser372Cys, both causing amino acid changes. Case Report: BSS is characterized by a range of morphological features, some more classically associated than others, of which craniosynostosis has been almost uniformly present. Other common features include cutis gyrata, acanthosis nigricans, ear and eye defects, skin/mucosal tissue tags, prominent umbilical stump, and anogenital anomalies. This account reports what we believe to be the 25th case of BSS, and exhibits a constellation of the characteristic features similar to those previously described, including the presence of cutis gyrata, proptosis, a bifid scrotum, and hypospadias. However, craniosynostosis was not detected prenatally by ultrasound or at birth. Prenatal ultrasound may detect some dysmorphic features of BSS. Many of these features have also been associated with other genetic disorders with overlapping phenotypes. Our case presented with the unusual features of a natal tooth and absence of craniosynostosis at birth. At birth, a diagnosis of BSS was suspected based on clinical features despite the absence of craniosynostosis. This was later confirmed with the use of molecular analysis, revealing a Tyr375Cys mutation of exon 9 of the FGFR2 gene. Conclusions: We suggest that a normal antenatal ultrasound scan and the absence of craniosynostosis at birth should not preclude further workup for BSS if this possibility is clinically suspected

Diving in: Using a “Shark Tank” approach to teach business skills to future DNP leaders

Doctor of Nursing Practice (DNP) education prepares graduates to lead clinical improvement and innovation across practice settings. Advanced clinical knowledge, leadership skills, and the development of quality/safety competencies uniquely prepare the DNP program graduates to drive organizational change. Adding business and financial competencies to the skill set of DNP graduates strengthens the impact and value of their role on financial, quality, and operational outcomes. The Organizational Systems and Healthcare Financing course in a DNP program was redesigned to engage learners using an innovative approach to teach business and financial principles. This paper aims to (a) describe a novel “Shark Tank” approach whereby students develop and “pitch” their business proposals to a panel of healthcare executives; (b) share examples of impactful change projects by student teams; (c) report DNP course and program evaluations including students’ satisfaction and perceptions of value and knowledge gained in business principles; and (d) report opportunities for bidirectional mentorship, faculty recruitment, and succession planning. The success of this innovative team-based approach for teaching business/financial skills better prepares future DNP leaders and has implications for other DNP programs. Using this teaching strategy created opportunities for faculty recruitment, succession planning, and bidirectional mentorship of DNP-prepared nurse leaders

THE UNIVERSITY ENGLISH LECTURER: COLLEAGUE OR COMMODITY

Consumer demands and annual budgetary inconsistencies have caused today's postsecondary academic landscape to continuously shift and change. Challenges to remain competitive or simply survive impact postsecondary institutions at their most fundamental level: those who are teaching the core curricula. Within the discipline of English, lecturers teach the core undergraduate composition courses. They usually work on annual contracts and maintain 4/4 teaching loads with little, if any, job security, for low wages, long hours, and less prestige within the academic community. Yet, the number of postgraduates applying for lectureship positions seems endless. In light of the current academic culture this study asks: is the university English lecturer considered a colleague, or a commodity? The conclusions of the eight participants from six public universities within the University of North Carolina (UNC) system are: 1) Lecturers felt that they and their courses were marginalized by their institutions and to an extent, by their peers. 2) Job satisfaction was linked to the department and to their students rather than to their institution or peers. 3) Validation from teaching and control in their classrooms compensated for the heavy workload, poor wages, and job insecurity. 4) All lecturers felt more status over adjunct faculty but MAs felt less valued than those with PhDs. 5) Lecturers with terminal degrees showed more discontent and viewed this position as transitory. 6) All participants saw themselves as valid contributing professionals and thought that teaching composition was an honorable and important contribution to the institution, department, and to student development

Quantifying and monetizing potential climate change policy impacts on terrestrial ecosystem carbon storage and wildfires in the United States

This paper develops and applies methods to quantify and monetize projected impacts on terrestrial ecosystem carbon storage and areas burned by wildfires in the contiguous United States under scenarios with and without global greenhouse gas mitigation. The MC1 dynamic global vegetation model is used to develop physical impact projections using three climate models that project a range of future conditions. We also investigate the sensitivity of future climates to different initial conditions of the climate model. Our analysis reveals that mitigation, where global radiative forcing is stabilized at 3.7 W/m2 in 2100, would consistently reduce areas burned from 2001 to 2100 by tens of millions of hectares. Monetized, these impacts are equivalent to potentially avoiding billions of dollars (discounted) in wildfire response costs. Impacts to terrestrial ecosystem carbon storage are less uniform, but changes are on the order of billions of tons over this time period. The equivalent social value of these changes in carbon storage ranges from hundreds of billions to trillions of dollars (discounted). The magnitude of these results highlights their importance when evaluating climate policy options. However, our results also show national outcomes are driven by a few regions and results are not uniform across regions, time periods, or models. Differences in the results based on the modeling approach and across initializing conditions also raise important questions about how variability in projected climates is accounted for, especially when considering impacts where extreme or threshold conditions are important.United States. Environmental Protection Agency. Climate Change Division (Contract EP-BPA-12-H-0024

Dynamics Impact Tolerance of Shuttle RCC Leading Edge Panels Using LS-DYNA

This paper describes a research program conducted to enable accurate prediction of the impact tolerance of the shuttle Orbiter leading-edge wing panels using physics-based codes such as LS-DYNA, a nonlinear, explicit transient dynamic finite element code. The shuttle leading-edge panels are constructed of Reinforced-Carbon-Carbon (RCC) composite material, which is used because of its thermal properties to protect the shuttle during reentry into the Earth's atmosphere. Accurate predictions of impact damage from insulating foam and other debris strikes that occur during launch required materials characterization of expected debris, including strain-rate effects. First, analytical models of individual foam and RCC materials were validated. Next, analytical models of foam cylinders impacting 6- in. x 6-in. RCC flat plates were developed and validated. LS-DYNA pre-test models of the RCC flat plate specimens established the impact velocity of the test for three damage levels: no-detectable damage, non-destructive evaluation (NDE) detectable damage, or visible damage such as a through crack or hole. Finally, the threshold of impact damage for RCC on representative Orbiter wing panels was predicted for both a small through crack and for NDE-detectable damage

Dynamic Impact Tolerance of Shuttle RCC Leading Edge Panels using LS-DYNA

This paper describes a research program conducted to enable accurate prediction of the impact tolerance of the shuttle Orbiter leading-edge wing panels using 'physics-based- codes such as LS-DYNA, a nonlinear, explicit transient dynamic finite element code. The shuttle leading-edge panels are constructed of Reinforced-Carbon-Carbon (RCC) composite material, which issued because of its thermal properties to protect the shuttle during re-entry into the Earth's atmosphere. Accurate predictions of impact damage from insulating foam and other debris strikes that occur during launch required materials characterization of expected debris, including strain-rate effects. First, analytical models of individual foam and RCC materials were validated. Next, analytical models of individual foam cylinders impacting 6-in. x 6-in. RCC flat plates were developed and validated. LS-DYNA pre-test models of the RCC flat plate specimens established the impact velocity of the test for three damage levels: no-detectable damage, non-destructive evaluation (NDE) detectable damage, or visible damage such as a through crack or hole. Finally, the threshold of impact damage for RCC on representative Orbiter wing panels was predicted for both a small through crack and for NDE-detectable damage

Once and Future Gulf of Mexico Ecosystem: Restoration Recommendations of an Expert Working Group

The Deepwater Horizon (DWH) well blowout released more petroleum hydrocarbons into the marine environment than any previous U.S. oil spill (4.9 million barrels), fouling marine life, damaging deep sea and shoreline habitats and causing closures of economically valuable fisheries in the Gulf of Mexico. A suite of pollutants—liquid and gaseous petroleum compounds plus chemical dispersants—poured into ecosystems that had already been stressed by overfishing, development and global climate change. Beyond the direct effects that were captured in dramatic photographs of oiled birds in the media, it is likely that there are subtle, delayed, indirect and potentially synergistic impacts of these widely dispersed, highly bioavailable and toxic hydrocarbons and chemical dispersants on marine life from pelicans to salt marsh grasses and to deep-sea animals. As tragic as the DWH blowout was, it has stimulated public interest in protecting this economically, socially and environmentally critical region. The 2010 Mabus Report, commissioned by President Barack Obama and written by the secretary of the Navy, provides a blueprint for restoring the Gulf that is bold, visionary and strategic. It is clear that we need not only to repair the damage left behind by the oil but also to go well beyond that to restore the anthropogenically stressed and declining Gulf ecosystems to prosperity-sustaining levels of historic productivity. For this report, we assembled a team of leading scientists with expertise in coastal and marine ecosystems and with experience in their restoration to identify strategies and specific actions that will revitalize and sustain the Gulf coastal economy. Because the DWH spill intervened in ecosystems that are intimately interconnected and already under stress, and will remain stressed from global climate change, we argue that restoration of the Gulf must go beyond the traditional "in-place, in-kind" restoration approach that targets specific damaged habitats or species. A sustainable restoration of the Gulf of Mexico after DWH must: 1. Recognize that ecosystem resilience has been compromised by multiple human interventions predating the DWH spill; 2. Acknowledge that significant future environmental change is inevitable and must be factored into restoration plans and actions for them to be durable; 3. Treat the Gulf as a complex and interconnected network of ecosystems from shoreline to deep sea; and 4. Recognize that human and ecosystem productivity in the Gulf are interdependent, and that human needs from and effects on the Gulf must be integral to restoration planning. With these principles in mind, the authors provide the scientific basis for a sustainable restoration program along three themes: 1. Assess and repair damage from DWH and other stresses on the Gulf; 2. Protect existing habitats and populations; and 3. Integrate sustainable human use with ecological processes in the Gulf of Mexico. Under these themes, 15 historically informed, adaptive, ecosystem-based restoration actions are presented to recover Gulf resources and rebuild the resilience of its ecosystem. The vision that guides our recommendations fundamentally imbeds the restoration actions within the context of the changing environment so as to achieve resilience of resources, human communities and the economy into the indefinite future