Student Internships in Extension: Strategies for Success for the Agent and the Student

The Extension internship provides a valuable learning experience for the agent and the intern. The intern receives a lesson in real-world-learning ; for many agents, supervising an intern is an opportunity to update their knowledge and skills. Too often the intern and the agent are not a good match, leaving both parties dissatisfied and disappointed. This article offers three perspectives of the internship experience, that of the agent, the intern, and campus supervisor. We offer suggestions for strategies agents can use to enhance the internship experience for all involved and remind the reader that internships are an excellent recruiting tool

Integrated stratigraphy of the Kimmeridge Clay Formation (Upper Jurassic) based on exposures and boreholes in south Dorset, UK

For the purposes of a high-resolution multi-disciplinary study of the Upper Jurassic Kimmeridge Clay Formation, two boreholes were drilled at Swanworth Quarry and one at Metherhills, south Dorset, UK. Together, the cores represent the first complete section through the entire formation close to the type section. We present graphic logs that record the stratigraphy of the cores, and outline the complementary geophysical and analytical data sets (gamma ray, magnetic susceptibility, total organic carbon, carbonate, [delta]13Corg). Of particular note are the new borehole data from the lowermost part of the formation which does not crop out in the type area. Detailed logs are available for download from the Kimmeridge Drilling Project web-site at http://kimmeridge.earth.ox.ac.uk/. Of further interest is a mid-eudoxus Zone positive shift in the [delta]13Corg record, a feature that is also registered in Tethyan carbonate successions, suggesting that it is a regional event and may therefore be useful for correlation. The lithostratigraphy of the cores has been precisely correlated with the nearby cliff section, which has also been examined and re-described. Magnetic-susceptibility and spectral gamma-ray measurements were made at a regular spacing through the succession, and facilitate core-to-exposure correlation. The strata of the exposure and core have been subdivided into four main mudrock lithological types: (a) medium-dark–dark-grey marl; (b) medium-dark–dark grey–greenish black shale; (c) dark-grey–olive-black laminated shale; (d) greyish-black–brownish-black mudstone. The sections also contain subordinate amounts of siltstone, limestone and dolostone. Comparison of the type section with the cores reveals slight lithological variation and notable thickness differences between the coeval strata. The proximity of the boreholes and different parts of the type section to the Purbeck–Isle of Wight Disturbance is proposed as a likely control on the thickness changes

Assessing Physician Response Rate Using a Mixed-Mode Survey

Background. It is important to minimize time and cost of physician surveys while still achieving a reasonable response rate. Mixed-mode survey administration appears to improve response rates and decrease bias. A literature review revealed physician response rates to mixed-mode surveys averaged about 68%. However, no identified studies used the combination of e-mail, fax, and telephone. The purpose of this study was to evaluate physician response rates based on surveys first administered by e-mail, then fax, then telephone. Methods. Surveys initially were administered by e-mail to 149 physicians utilizing SurveyMonkey©. Two follow-up reminder e-mails were sent to non-respondents at two-week intervals. Surveys then were faxed to physicians who had not responded. A follow-up fax was sent to non-respondents one week later. Finally, phone interviews were attempted with physicians who had not responded by e-mail or fax; each physician was called at least twice. Results. Of the 149 eligible physicians, 102 completed the survey for a response rate of 68.5%. Of those who responded, 49 (48%) responded by e-mail, 25 (24.5%) by fax, and 28 (27.5%) by phone. Mode of response did not differ by gender, specialization, or years in practice. In addition, mode of response was not related to the primary study question, physician willingness to use text messaging for immunization reminders. Conclusions. This mix of survey methodologies appeared to be a feasible combination for achieving physician responses and may be more cost effective than other mixed methods

Using Radiological Data to Estimate Ischemic Stroke Severity

Background Risk-adjusted poststroke mortality has been proposed for use as a measure of stroke care quality. Although valid measures of stroke severity (e.g., the National Institutes of Health Stroke Scale [NIHSS]) are not typically available in administrative datasets, radiology reports are often available within electronic health records. We sought to examine whether admission head computed tomography data could be used to estimate stroke severity. Materials and Methods Using chart review data from a cohort of acute ischemic stroke patients (1998-2003), we developed a radiographic measure ([BIS]) of stroke severity in a two-third development set and assessed in a one-third validation set. The retrospective NIHSS was dichotomized as mild/moderate (<10) and severe (≥10). We compared the association of this radiographic score with NIHSS and in-hospital mortality at the patient level. Results Among 1348 stroke patients, 86.5% had abnormal findings on initial head computed tomography. The c-statistic for the BIS for modeling severe stroke (development, .581; validation, .579) and in-hospital mortality (development, .623; validation, .678) were generated. Conclusions Although the c-statistics were only moderate, the BIS provided significant risk stratification information with a 2-variable score. Until administrative data routinely includes a valid measure of stroke severity, radiographic data may provide information for use in risk adjustment

Increased prevalence of pregnancy and comparative risk of program attrition among individuals starting HIV treatment in East Africa

Background The World Health Organization now recommends initiating all pregnant women on life-long antiretroviral therapy (ART), yet there is limited information about the characteristics and program outcomes of pregnant women already on ART in Africa. Our hypothesis was that pregnant women comprised an increasing proportion of those starting ART, and that sub-groups of these women were at higher risk for program attrition. Methods and findings We used the International Epidemiology Databases to Evaluate AIDS- East Africa (IeDEA-EA) to conduct a retrospective cohort study including HIV care and treatment programs in Kenya, Uganda, and Tanzania. The cohort consecutively included HIV-infected individuals 13 years or older starting ART 2004–2014. We examined trends over time in the proportion pregnant, their characteristics and program attrition rates compared to others initiating and already receiving ART. 156,474 HIV-infected individuals (67.0% women) started ART. The proportion of individuals starting ART who were pregnant women rose from 5.3% in 2004 to 12.2% in 2014. Mean CD4 cell counts at ART initiation, weighted for annual program size, increased from 2004 to 2014, led by non-pregnant women (annual increase 20 cells/mm3) and men (17 cells/mm3 annually), with lower rates of change in pregnant women (10 cells/mm3 per year) (p<0.0001). There was no significant difference in the cumulative incidence of program attrition at 6 months among pregnant women starting ART and non-pregnant women. However, healthy pregnant women starting ART (WHO stage 1/2) had a higher rate of attrition rate (9.6%), compared with healthy non-pregnant women (6.5%); in contrast among women with WHO stage 3/4 disease, pregnant women had lower attrition (8.4%) than non-pregnant women (14.4%). Among women who initiated ART when healthy and remained in care for six months, subsequent six-month attrition was slightly higher among pregnant women at ART start (3.5%) compared to those who were not pregnant (2.4%), (absolute difference 1.1%, 95% CI 0.7%-1.5%). Conclusions Pregnant women comprise an increasing proportion of those initiating ART in Africa, and pregnant women starting ART while healthy are at higher risk for program attrition than non-pregnant women. As ART programs further expand access to healthier pregnant women, further studies are needed to better understand the drivers of loss among this high risk group of women to optimize retention

Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting

Abstract—Falls are a serious medical complication following stroke. The objectives of this study were to (1) confirm the prevalence of falls among patients with stroke during acute hospitalization, (2) identify factors associated with falls during the acute stay, and (3) examine whether in-hospital falls were associated with loss of function after stroke (new dependence at discharge). We completed a secondary analysis of data from a retrospective cohort study of patients with ischemic stroke who were hospitalized at one of four hospitals. We used logistic regression to identify factors associated with inpatient falls and examine the association between falls and loss of function. Among 1,269 patients with stroke, 65 (5%) fell during the acute hospitalization period. We found two characteristics independently associated with falls: greater stroke severity (National Institutes of Health Stroke Scale [NIHSS] 8, adjusted odds ratio [OR] = 3.63, 95% confidence interval [CI]: 1.46–9.00) and history of anxiety (adjusted OR = 4.90, 95% CI: 1.70–13.90). Falls were independently associated with a loss of function (adjusted OR = 9.85, 95% CI: 1.22–79.75) even after adjusting for age, stroke severity, gait abnormalities, and past stroke. Stroke severity (NIHSS 8) may be clinically useful during the acute inpatient setting in identifying those at greatest risk of falling. Given the association between falls and poor patient outcomes, rehabilitation interventions should be implemented to prevent falls poststroke

Diagnosis and treatment of pediatric acquired aplastic anemia (AAA): An initial survey of the North American Pediatric Aplastic Anemia Consortium (NAPAAC)

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106711/1/pbc24875.pd

Adaptive Wolf Management: The Regulated Public Harvest Component

Montana’s wolf (Canis lupus) conservation and management plan is based on adaptive management principles and includes regulated public harvest as a population management tool. The need and opportunity to implement public harvest in 2008, 2009, and 2010 required Montana Fish, Wildlife and Parks (FWP) to develop a stepped down adaptive management framework specific to harvest. For 2008 and 2009, FWP set modest objectives: implement a harvest, maintain a recovered population, and begin the learning process to inform development of future hunting regulations and quotas. In 2010, FWP used a formal Structured Decision Making Process to more clearly define priorities and challenges of setting a wolf season, outline objectives of a successful season, and evaluate consequences and trade-offs between alternative management actions. For all years, FWP used a modeling process to simulate a wide range of harvest rates across three harvest units and to predict harvest effects on the minimum number of wolves, packs and breeding pairs. Model inputs were derived from minimum wolf numbers observed in the field. Modeling allowed consideration of a range of harvest quotas, predicted outcomes, and risk that harvest could drive the population below federally-required minimums. It also facilitated explicit consideration of how well a particular quota achieved objectives and how to adapt future regulations and quotas. Legal challenges to federal delisting restricted implementation of the first fair chase hunting season to 2009. Montana’s wolf population is securely recovered, despite the dynamic political and legal environments. Regardless, FWP remains committed to a scientific, data-driven approach to adaptive management