Holding On: Older Californians With Disabilities Rely on Public Services to Remain Independent

Presents findings from a study of low-income older Californians with disabilities receiving Medicare, Medi-Cal, and In-Home Supportive Services; their unmet physical, mental health, and social needs; and limited care options. Outlines policy implications

Are self-identified "disadvantaged" students less likely to enter surgical residencies? A single-institution study.

BackgroundGiven more emphasis on training primary care physicians for underserved areas, we hypothesized that students self-identifying as "disadvantaged" would be less likely to pursue surgical training.MethodsWe retrospectively reviewed medical school data on students graduating 2005-2014. Students were stratified into "disadvantaged" and "nondisadvantaged". Data were recorded on age, grade point average, Medical College Admission Test (MCAT), gender, surgery grade, United States Medical Licensing Examination step 1 score, and residency match into a surgical field. A comparison of the proportion of students matching into a surgical field was assessed with chi-square test. Multivariate logistic regression was performed to assess the factors that predict the choice of general surgery versus another surgical field.ResultsOf the 1140 students who graduated during the study period, 219 (19.2%) students self-identified as "disadvantaged". Of all students, 158 (13.9%) chose a surgical field. The disadvantaged group was older at entry and had lower grade point average and total MCAT scores. Twenty-seven (12.3%) disadvantaged students chose a surgical residency versus 130 (14.1%) nondisadvantaged students (P = 0.56). On multivariate logistic regression, female gender (odds ratio [OR] = 3.9; 95% confidence interval = [1.9-8.3], P < 0.01), disadvantaged status (OR = 2.8 [1.1-7.1], P = 0.03), and United States Medical Licensing Examination step 1 score ≥ 227 (OR = 0.43 [0.21-0.88], P = 0.02) were significantly associated with matching into general surgery versus another surgical specialty.DiscussionAlthough the disadvantaged cohort was older and had lower undergraduate GPAs and MCAT scores, the proportion of disadvantaged students matching into a surgical residency was not statistically different. To address the future shortage of general surgeons in underserved areas, increasing enrollment of "disadvantaged" students may alleviate the "surgical desert"

Using formative evaluation in an implementation project to increase vaccination rates in high-risk veterans: QUERI Series

<p>Abstract</p> <p>Background</p> <p>Implementation of research into practice in health care systems is a challenging and often unsuccessful endeavor. The United States Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) research teams include formative evaluations (FE) in their action-oriented VA implementation projects to identify critical information about the processes of implementation that can guide adjustments to project activities, in order to better meet project goals. This article describes the development and use of FE in an action-oriented implementation research project.</p> <p>Methods</p> <p>This two-year action-oriented implementation research project was conducted at 23 VA Spinal Cord Injury (SCI) Centers, and targeted patients, staff and the system of care, such as administration and information technology. Data for FE were collected by electronic and paper surveys, semi-structured and open-ended interviews, notes during conference calls, and exchange of e-mail messages. Specific questions were developed for each intervention (designed to improve vaccination rates for influenza in veterans with spinal cord injury and disorder); informants were selected for their knowledge of interventions and their use in SCI Centers.</p> <p>Results</p> <p>Data from FE were compiled separately for each intervention to describe barriers to progress and guide adjustments to implementation activities. These data addressed the processes of implementing the interventions, problem-solving activities and the status of interventions at SCI Centers.</p> <p>Conclusion</p> <p>Formative evaluations provided the project team with a broad view of the processes of implementing multi-targeted interventions as well as the evolving status of the related best practice. Using FE was useful, although the challenges of conducting FE for non-field researchers should be addressed. Work is needed to develop methods for conducting FE across multiple sites, as well as acknowledging variations in local contexts that affect implementation of interventions.</p

Status of the PALM-3000 high order adaptive optics instrument

We report on the status of PALM-3000, the second generation adaptive optics instrument for the 5.1 meter Hale telescope at Palomar Observatory. PALM-3000 was released as a facility class instrument in October 2011, and has since been used on the Hale telescope a total of over 250 nights. In the past year, the PALM-3000 team introduced several instrument upgrades, including the release of the 32x32 pupil sampling mode which allows for correction on fainter guide stars, the upgrade of wavefront sensor relay optics, the diagnosis and repair of hardware problems, and the release of software improvements. We describe the performance of the PALM-3000 instrument as a result of these upgrades, and provide on-sky results. In the 32x32 pupil sampling mode (15.8 cm per subaperture), we have achieved K-band strehl ratios as high as 11% on a 14.4 mv star, and in the 64x64 pupil sampling mode (8.1 cm per subaperture), we have achieved K-band strehl ratios as high as 86% on stars brighter than 7th m_v

Nonlinear mixing behavior of the three-dimensional Rayleigh–Taylor instability at a decelerating interface

Results are reported from the first experiments to explore the evolution of the Rayleigh–Taylor (RT) instability from intentionally three-dimensional (3D) initial conditions at an embedded, decelerating interface in a high-Reynolds-number flow. The experiments used ∼ 5 kJ∼5kJ of laser energy to produce a blast wave in polyimide and/or brominated plastic having an initial pressure of ∼ 50 Mbars.∼50Mbars. This blast wave shocked and then decelerated the perturbed interface between the first material and lower-density C foam. This caused the formation of a decelerating interface with an Atwood number ∼ 2/3,∼2/3, producing a long-term positive growth rate for the RT instability. The initial perturbations were a 3D perturbation in an “egg-crate” pattern with feature spacings of 71 μm in two orthogonal directions and peak-to-valley amplitudes of 5 μm. The resulting RT spikes appear to overtake the shock waves, moving at a large fraction of the predeceleration, “free-fall” velocity. This result was unanticipated by prior simulations and models. © 2004 American Institute of Physics.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69657/2/PHPAEN-11-5-2829-1.pd

Design and performance of the PALM-3000 3.5 kHz upgrade

PALM-3000 (P3K), the second-generation adaptive optics (AO) instrument for the 5.1 meter Hale telescope at Palomar Observatory, underwent a significant upgrade to its wavefront sensor (WFS) arm and real-time control (RTC) system in late 2019. Main features of this upgrade include an EMCCD WFS camera capable of 3.5 kHz framerates and advanced Digital Signal Processor (DSP) boards to replace the aging GPU based real-time control system. With this upgrade P3K is able to maintain a lock on natural guide stars fainter than mV=16. Here we present the design and on-sky re-commissioning results of the upgraded system

Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?

Purpose: To evaluate the value of enhanced optometric services for managing neovascular age‐related macular degeneration (nAMD) and glaucoma in primary care optometry services, instead of hospital eye services (HES). Methods: Seven enhanced optometric service pathways in primary care in Wales were assessed with a mixed‐methods approach: three for nAMD and four for glaucoma. The methods were a patient‐related experience measure (PREM), a Realist Review and Evaluation involving both patients and staff, a discrete event simulation model estimating the economic impact of the pathways and a workforce survey of optometrists to gauge capability and capacity. Results: Patient‐related experience measure responses (802) indicated that primary care experience was comparable to that of HES. Utilising enhanced optometric services in primary care resulted in reduced wait times compared with HES, with suspected nAMD shortened to 4–5 days and glaucoma monitoring to 5 days. Waiting lists were dramatically reduced with primary care‐based services to just three people waiting for nAMD and five for glaucoma, compared with 216 and 5691 people, respectively, in HES. Consultant ophthalmologist time was reduced from 57% to 15%–16% for nAMD services and from 48% to 22%–23% for glaucoma services. Integrating enhanced optometric services into primary care incurred a similar cost. The workforce survey confirms that optometrists possess the skills and qualifications and are willing to deliver these enhanced optometric services. The Realist Review and Evaluation revealed that clear patient communication, effective coordination and strong interprofessional communication between optometrists and ophthalmologists along with a shared electronic record are crucial to the success of this change. Conclusion: Providing enhanced optometric services in primary care for nAMD and glaucoma brings substantial benefits for the UK National Health Service and patients, including reduced waiting times, waiting lists and released HES capacity. The success of this transition hinges on clear patient communication, administrative co‐ordination and effective interprofessional communication

Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration

BACKGROUND: Facilitation has been identified in the literature as a potentially key component of successful implementation. It has not, however, either been well-defined or well-studied. Significant questions remain about the operational definition of facilitation and about the relationship of facilitation to other interventions, especially to other change agent roles when used in multi-faceted implementation projects. Researchers who are part of the Quality Enhancement Research Initiative (QUERI) are actively exploring various approaches and processes, including facilitation, to enable implementation of best practices in the Veterans Health Administration health care system – the largest integrated healthcare system in the United States. This paper describes a systematic, retrospective evaluation of implementation-related facilitation experiences within QUERI, a quality improvement program developed by the US Department of Veterans Affairs. METHODS: A post-hoc evaluation was conducted through a series of semi-structured interviews to examine the concept of facilitation across several multi-site QUERI implementation studies. The interview process is based on a technique developed in the field of education, which systematically enhances learning through experience by stimulating recall and reflection regarding past complex activities. An iterative content analysis approach relative to a set of conceptually-based interview questions was used for data analysis. FINDINGS: Findings suggest that facilitation, within an implementation study initiated by a central change agency, is a deliberate and valued process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship. Facilitation was described primarily as a distinct role with a number of potentially crucial behaviors and activities. Data further suggest that external facilitators were likely to use or integrate other implementation interventions, while performing this problem-solving and supportive role. PRELIMINARY CONCLUSIONS: This evaluation provides evidence to suggest that facilitation could be considered a distinct implementation intervention, just as audit and feedback, educational outreach, or similar methods are considered to be discrete interventions. As such, facilitation should be well-defined and explicitly evaluated for its perceived usefulness within multi-intervention implementation projects. Additionally, researchers should better define the specific contribution of facilitation to the success of implementation in different types of projects, different types of sites, and with evidence and innovations of varying levels of strength and complexity

The \u3cem\u3eChlamydomonas\u3c/em\u3e Genome Reveals the Evolution of Key Animal and Plant Functions

Chlamydomonas reinhardtii is a unicellular green alga whose lineage diverged from land plants over 1 billion years ago. It is a model system for studying chloroplast-based photosynthesis, as well as the structure, assembly, and function of eukaryotic flagella (cilia), which were inherited from the common ancestor of plants and animals, but lost in land plants. We sequenced the ∼120-megabase nuclear genome of Chlamydomonas and performed comparative phylogenomic analyses, identifying genes encoding uncharacterized proteins that are likely associated with the function and biogenesis of chloroplasts or eukaryotic flagella. Analyses of the Chlamydomonas genome advance our understanding of the ancestral eukaryotic cell, reveal previously unknown genes associated with photosynthetic and flagellar functions, and establish links between ciliopathy and the composition and function of flagella