A Language Arts Project Involving the Construction of a Solar Greenhouse by Navajo Children

This paper, in three parts, explains why and how fifth and sixth grade students at a Navajo bilingual elementary school in New Mexico built a solar greenhouse as a language arts project. The first part catalogues the English speaking, reading, and writing needs of the children. It details the rationale behind building a greenhouse to address these needs. The second part is the greenhouse project itself. It contains English lessons which the students used as guidelines for planning and building the greenhouse structure. The third part, found in the Appendix, contains one of the students\u27 workbooks. I hope this serves someone in good stead. The project could never be literally duplicated, because it was closely tied up with the particular requirements of the students, the school, the place, and the available resources. But it may facilitate other teachers in developing their own answers. That\u27s what I\u27m hoping for

Endoscopic endonasal management of recurrent petrous apex cholesterol granuloma.

Petrous apex cholesterol granulomas (PACG) are uncommon lesions. Recurrence following transcranial or endonasal approaches to aerate the cyst occurs in up to 60% of cases. We describe the technical nuances pertinent to the endonasal endoscopic management of a recurrent symptomatic PACG and review the literature. A 19-year-old woman presented with a recurrent right abducens nerve paresis. Four months prior, she underwent an endonasal transsphenoidal surgery (TSS) for drainage of a symptomatic PACG. Current imaging documented recurrence of the right PACG. Transsphenoidal and infrapetrous approaches were performed to obtain a wider bony opening along the petrous apex and drain the cyst. A Doyle splint was inserted into the cyst's cavity and extended out into the sphenoid, maintaining patency during the healing process. Three months after surgery, the splint was removed endoscopically, allowing visualization of a patent cylindrical communication between both aerated cavities. The patient remains symptom- and recurrence-free. Endoscopic endonasal surgery must be adapted to manage recurrent PACG. A TSS may not be sufficient. An infrapetrous approach with wider bony opening, extensive removal of the cyst's anterior wall, and use of a stent are indicated for the treatment of recurrent PACG and to prevent recurrences

Online ad auctions: an experiment

A human subject laboratory experiment compares the real-time market performance of the two most popular auction formats for online ad space, Vickrey- Clarke-Groves (VCG) and Generalized Second Price (GSP). Theoretical predictions made in papers by Varian (2007) and Edelman et al. (2007) seem to organize the data well overall. Efficiency under VCG exceeds that under GSP in nearly all treatments. The difference is economically significant in the more competitive parameter configurations and is statistically significant in most treatments. Revenue capture tends to be similar across auction formats in most treatments

Teaching the Use of Systems Dynamics for Strategic Decision Making in Healthcare

Having worked in the healthcare system and taught healthcare MBAs for over a decade, we have observed that healthcare systems and departments operate in independent silos. This paper shows how to use systems dynamics as a method to help students examine the big picture of how components fit together to form a system. We demonstrate the application of this approach and provide an example from one of our healthcare professional graduate student teams

Finding the Path to Innovation – Part 2

Industry leaders have been put on the defensive in their need to address mounting financial and operational concerns. In a previous, companion paper, it was suggested that healthcare managers need to balance financial challenges with innovative programming that enhances their strategic mix to find new ways to counter the disruption from the ACA. This paper illustrates a practical example of the applications of this innovation model which touches on three activities: (1) aligning the organization’s purpose with its markets, (2) piloting ideas, and (3) learning from a variety of stakeholders in and outside of the traditional healthcare domain. United HealthGroup (UHG) has developed a new program in the area of health literacy (Just Plain Clear) that illustrates these principles. Based on the organization’s mission of “helping people live healthier lives” it was clear that there was a need to more effectively communicate with their customers. As part of their effort to pilot ideas UHG developed a tool to analyze documents to determine the reading levels needed to understand the documents used by their customers and how to modify then for easier reading. They then decided that a glossary of medical terms in English and Spanish would be a good way to begin addressing health literacy issues among its customers. Learning from stakeholders the UHG staff consulted with the Institute of Medicine; America’s Health Insurance Plans; medical schools at Northwestern University, Boston University, and the University of Missouri; the RAND Corporation; and the Center for Plain Language. In addition, UHG staff reviewed more than 800 journal articles on health literacy. In 2014, the Just Plain Clear website had 22,600 visitors and its use continues to grow. UHG considers this pilot program a success

Thinking Beyond the Affordable Care Act

Health care leaders are currently focused on implementing the many aspects of the Affordable Care Act. Although these initiatives are necessary, they are not sufficient to succeed strategi­cally in the healthcare reform environment. Success occurs with an organizational strategy that focuses on new processes and services that meet the healthcare and financial needs of the customer while disrupt­ing the status quo. Three strategic principles are recommended that can be used in helping organizations address disruptions or create their own. These three principles are: test a new business model against the needs of our customers; pilot test one or two new ideas to disrupt or counter disruption; look across disciplines for ideas and encouragement. Change management is far more difficult to enact than is communicated in books, lectures, and case studies. However, in this high-pressure healthcare environment, it is becoming imperative for managers to find a path to participate in positive disruptive solutions, or risk becoming victims of other organizations solutions

A naturalistic study of medication reduction in a residential treatment setting

The primary aim of this pilot study was to ascertain if psychiatric medications could be reduced in a convenience sample of seriously emotionally disturbed children and adolescents over the course of residential treatment. We also sought to understand factors correlated with reduction in the number of medications during treatment. A review of the treatment of 141 patients (n = 112 admitted on medication and n = 29 admitted on no medication) admitted to, and discharged from, a residential treatment setting between 1992 and 2001 was undertaken. Significantly more children were discharged from treatment on no medications than were admitted to residential treatment on no medications. In children receiving more than 1 medication at admission, the number of combined medications was significantly reduced over the course of residential treatment. However, the majority of children admitted on medications continued on some psychiatric medications, indicating that psychopharmacology continued to play an important role in their treatment. In 112 patients admitted on psychoactive medications, our pilot data suggests that improvement in externalizing, internalizing, psychotic, and autistic psychopathology while in residential treatment, the presence of an intact family (adoptive or biological), the absence of a history of either sexual or physical abuse, and the type of medication used appear to be factors that correlate with a reduced use of medications in this population

An investigation of factors influencing antimicrobial resistance in dairy herds

The emergence of antimicrobial resistance (AMR) as a result of the selective pressures placed on both commensal and pathogenic bacterial populations as a result of overuse and misuse of antimicrobials is one of the greatest issues facing human healthcare. Antimicrobials are widely used in agriculture for the maintenance of health and welfare, but their use also contributes to the issue of AMR and poses a risk to human health via the food chain. In order to tackle the challenge, governments and organisations across the world have committed to reducing antimicrobial use (AMU) in agriculture and to implement surveillance programmes to monitor AMR. Although AMU in agriculture in the United Kingdom (UK) is reducing, there remains a knowledge gap regarding the dynamics which exist in terms of AMU/AMR associations and the influences of the wider farm environment. This context provided the rationale behind the research carried out and presented in this thesis. Chapter 1 provides an overview of available literature to explore the context and an outline of research aims. In Chapter 2, a study group of sixteen dairy farms were recruited to investigate the associations between historical trends of AMU and AMR as part of a longitudinal study. AMU was determined over the course of six years and AMR was measured according to the minimum inhibitory concentration of sentinel bacterial species isolates from bulk tank milk samples. The findings of this Chapter demonstrated that higher levels of AMU did not necessarily represent higher levels of resistance and led to an interest in other influencing factors. Chapter 3 outlines a cross sectional study investigating the influences of farm management practices on levels of resistance on dairy farms. Data was sourced from two study groups, one of which represented the herds recruited in Chapter 2, and utilised questionnaire responses collected during farm visits. Data was analysed using a robust modelling procedure and highlighted a range of management procedures existing across the dairy farm which may be associated with levels of resistance in sentinel bacteria. Chapters 4 and 5 sought to outline a new laboratory based methodology which could be employed in the monitoring of on farm AMR via sampling of bulk tank milk. Initial investigations took the form of a pilot study, in which raw bulk tank milk samples were enriched using selective nutrient broths. The results of these initial investigations helped to inform a potential antimicrobial susceptibility testing (AST) methodology. This was further investigated with validation to compare experimental methodology with already established testing standards. Comparisons of the final methodology with validation steps demonstrated viability of the AST method. Investigations of AMU/AMR interactions were once again considered in Chapter 6. AMU data, collated from farm medicine use records, were obtained from farms where bulk tank milk samples were sourced as part of investigations in Chapter 5. Analysis indicated that where statistically significant relationships between AMU and AMR existed, these relationships were negatively correlated. Together, the findings of each of the Chapters presented in this thesis help to further our knowledge of the dynamics which exist with regards to AMR in the dairy farm setting, and provide an opportunity to further develop AMR surveillance across the industry