Barriers to Offering Vasectomy at Publicly Funded Family Planning Organizations in Texas

Few publicly funded family planning clinics in the United States offer vasectomy, but little is known about the reasons this method is not more widely available at these sources of care. Between February 2012 and February 2015, three waves of in-depth interviews were conducted with program administrators at 54 family planning organizations in Texas. Participants described their organization’s vasectomy service model and factors that influenced how frequently vasectomy was provided. Interview transcripts were coded and analyzed using a theme-based approach. Service models and barriers to providing vasectomy were compared by organization type (e.g., women’s health center, public health clinic) and receipt of Title X funding. Two thirds of organizations did not offer vasectomy on-site or pay for referrals with family planning funding; nine organizations frequently provided vasectomy. Organizations did not widely offer vasectomy because they could not find providers that would accept the low reimbursement for the procedure or because they lacked funding for men’s reproductive health care. Respondents often did not perceive men’s reproductive health care as a service priority and commented that men, especially Latinos, had limited interest in vasectomy. Although organizations of all types reported barriers, women’s health centers and Title X-funded organizations more frequently offered vasectomy by conducting tailored outreach to men and vasectomy providers. A combination of factors operating at the health systems and provider level influence the availability of vasectomy at publicly funded family planning organizations in Texas. Multilevel approaches that address key barriers to vasectomy provision would help organizations offer comprehensive contraceptive services.Population Research Cente

A note on the Zassenhaus product formula

We provide a simple method for the calculation of the terms c_n in the Zassenhaus product $e^{a+b}=e^a e^b \prod_{n=2}^{\infty} e^{c_n}$ for non-commuting a and b. This method has been implemented in a computer program. Furthermore, we formulate a conjecture on how to translate these results into nested commutators. This conjecture was checked up to order n=17 using a computer

Addressing Urban High-Poverty School Teacher Attrition by Addressing Urban High Poverty School Teacher Retention: Why Effective Teachers Perservere

Recruiting and retaining quality teachers specific for high-poverty schools in urban areas is a national concern, especially in light of the No Child Left Behind federal legislation. The educational realities, detrimental effects of poverty, and human despair that often depress low-income communities can prove to be quite overpowering for many teachers new to the profession and significantly contribute to high levels of teacher absenteeism, attrition rates, and teacher shortages. Examining this issue through a new lens, that being through the eyes of effective urban high-poverty school educators, has the potential to spark spirited conversations and debates among policy makers and educators alike so that significant polices and efforts can be developed and implemented. Therefore, the intent of this study was to develop a profile of high-quality educators who remain in urban high-poverty schools within a large metropolitan school district, and identify the indicators that influence them to remain. The results indicated that teachers who are African American, older, and more experienced define the profile of teachers most likely to remain beyond the first three years in this demanding setting. Additionally, these teachers reported that they remain because they believe they are well suited for teaching in high-poverty schools. Unless more attention is given to teacher retention, and why some educators are successful and persevere in even the most hard-to-staff schools, teacher attrition will continue to be a national concern

Observations and Performance of a Soil Nail Shoring Wall in Seattle Silts and Clays

The Seattle Central Library project, which replaced the existing downtown library, consists of a twelve-story building with several below-grade levels. The excavation encompassed an entire city block and had plan dimensions of approximately 250 feet by 240 feet. The original excavation depth was up to 53 feet in height. The excavation was made in highly overconsolidated Seattle silts and clays (Lawton Clay). The Lawton Clay has been documented to exhibit expansive behavior along planes of weakness associated with stress relief upon excavation. The original excavation was designed to be supported using a tieback soldier pile wall, typical of shoring systems retaining the Lawton Clay. A soil nail shoring wall design was submitted, and subsequently installed, as part of a design-build alternative. The soil nail shoring wall system consisted of temporary, top-down soil nail walls that utilized portions of the concrete basement walls of the existing library. Vertical elements and shotcrete facing were constructed in areas where the excavation extended beyond or below the existing basement walls. Soil nails were installed using self-boring grout-injected anchors consisting of hollow bars with sacrificial drill bits. Displacement of the soil nail shoring walls was predicted to be less than 1 inch by the designer. The actual wall movements for three sides of the excavation were as predicted. However, the east wall on the uphill side of the excavation experienced 4 inches of lateral movement and over 2.5 inches of vertical movement, causing damage to the adjacent street and necessitating extensive design modifications during construction. In addition, the excavation depth was reduced to 47 feet because of significant movement occurring below the excavation. This paper describes the construction and observed behavior of the east wall and the applicability of soil nail walls in the Lawton Clay deposit

Incentive-based approaches to sustainable fisheries

The failures of traditional target-species management have led many to propose an ecosystem approach to fisheries to promote sustainability. The ecosystem approach is necessary, especially to account for fishery-ecosystem interactions, but by itself is not sufficient to address two important factors contributing to unsustainable fisheries — inappropriate incentives bearing on fishers, and the ineffective governance that frequently exists in commercial, developed fisheries managed primarily by total harvest limits and input-controls. We contend that much greater emphasis must be placed on fisher motivation when managing fisheries. Using evidence from more than a dozen ‘natural experiments’ in commercial fisheries, we argue that incentive-based approaches that better specify community, individual harvest, or territorial rights and also price ecosystem services — coupled with public research, monitoring and effective oversight — promote sustainable fisheries.incentives, sustainability, rights, fisheries management

Incentive-based approaches to sustainable fisheries (now replaced by EEN0508)

Using examples from more than a dozen fisheries, we highlight the failures of ‘command control’ management and show that approaches that empower fishers with the incentives and the mandate to be co-custodians of the marine environment can promote sustainability. Evidence is provided that where harvesters share well-defined management responsibilities over fish, and experience both the pain of overexploitation and the gains from conservation, they are much more likely to protect fish stocks and habitat. The key insight is that to maintain marine ecosystems for present and future generations, fishing incentives must be compatible with long-term goals of sustainability.incentives, sustainability, rights, fisheries management

Prevalence and Correlates of Diagnosed and Undiagnosed Hypertension in the Indigenous Kuna Population of Panamá

Background: To determine the prevalence of hypertension and investigate sociodemographic correlates in an indigenous Kuna community living on the San Blas islands of Panama. Methods: Data was collected from adults using a paper-based survey using a cross sectional study design. Blood pressure was measured, and hypertension defined at two cut-points: 130/80 mmHg and 140/90 mmHg. Individuals with undiagnosed hypertension had a blood pressure measurement that indicated hypertension, however, the individual had not been told by a doctor they had hypertension. Whereas individuals with diagnosed hypertension had been told by a healthcare provider that they had hypertension. Univariate tests compared diagnosed and undiagnosed hypertension by sociodemographic categories and logistic regression models tested individual correlates adjusting for all sociodemographic factors. Results: Two hundred and eleven adult indigenous Kuna participated in the study. Overall prevalence of hypertension was 6.2% (95%CI:3.32–10.30) as defined by 140/90 mmHg, and 16.6% (95%CI:11.83–22.31) as defined by 130/80 mmHg. Hypertension was significantly higher in men (31.6, 95% CI:19.90–45.24, compared to 11.0, 95% CI:6.56–17.09). Individuals with low income were 3 times more likely to be hypertensive (OR = 3.13, 95% CI:1.02–9.60) and 3.5 times more likely to have undiagnosed hypertension (OR = 3.42, 95% CI:1.01–11.52); while those with moderate income were 6 times more likely to be hypertensive (OR = 7.37, 95% CI:1.76–30.90) compared to those who were poor. Conclusion: The prevalence of diagnosed and undiagnosed hypertension is higher in men and those with higher income. Investigating these factors remains vitally important in helping improve the health of the Kuna through targeted interventions to address chronic disease