Social Screaming

I KNOW A LOT of people must have lectured to you about the adjustments that have to be made when you move into a sorority house, and I agree wholeheartedly with all of them. In fact, the only trouble is that there are some adjustments that are always overlooked. Screaming is one of them..

The Ugliest Child

PAM, your mother\u27s here. Hurry and I\u27ll take you down to see her. There was a small explosion in the cabin as Pam raced around getting dressed and the other campers roused themselves from their eternal games of jacks..

Benefits and Barriers of HUD Neighborhood Stabilization Program As Perceived by Stakeholders

Devalued homes and weakened economic conditions of 2008 led to lost property tax revenues, more vacant and abandoned properties, and destabilized neighborhoods. The first Neighborhood Stabilization Program (NSP1) was a federal intervention designed to mitigate the damage of the recession, but there is scant evidence of program effectiveness. A phenomenological study, using a method outlined by Moustakas, answered questions on the benefits and barriers of NSP1 as perceived by stakeholders in a Mid-Atlantic city. Stakeholders included nonprofit housing advocates, residents, business partners, and government officials. Theories of collaborative governance and community stakeholders were used to guide the investigation of NSP1 processes and stakeholders\u27 perceptions. Ten stakeholders responded to 9 compound interview questions derived from the research question and 4 subquestions in semi-structured interviews. Responses were transcribed, verified for accuracy, and then coded and analyzed for recurring themes. Five prominent themes emerged: (1) challenges with NSP1 guidelines, (2) importance of partner capacity, (3) positive results in targeted neighborhoods, (4) city\u27s approach to community development, and (5) sustaining positive results. Findings were that NSP1\u27s benefits for residents outweighed procedural barriers and NSP1\u27s short duration still yielded positive results in neighborhoods. This study has policy and social change implications for all stakeholders involved. Recommendations include continuous city involvement to stabilize neighborhoods during future recessions and better entrepreneurial strategies to integrate private and non-profit stakeholders in all phases of collaborative governance

Tides and Overtides in Long Island Sound

Using observations obtained by acoustic Doppler profilers and coastal water level recorders, we describe the vertical and horizontal structure of the currents and sea level due to the principal tidal constituents in Long Island Sound, a shallow estuary in southern New England. As expected, the observations reveal that M2 is the dominant constituent in both sea surface and velocity at all depths and sites. We also find evidence that the vertical structure of the M2 tidal current ellipse parameters vary with the seasonal evolution of vertical stratification at some sites. By comparing our estimates of the vertical structure of the M2 amplitudes to model predictions, we demonstrate that both uniform and vertically variable, time invariant eddy viscosities are not consistent with our measurements in the Sound. The current records from the western Sound contain significant overtides at the M4 and M6 frequencies with amplitudes and phases that are independent of depth. Though the M4 amplitude decreases to the west in proportion to M2, the M6 amplifies. Since the dynamics that generate overtides also produce tidal residuals, this provides a sensitive diagnostic of the performances of numerical circulation models. We demonstrate that the observed along-Sound structure of the amplitude of the M4 and M6 overtides is only qualitatively consistent with the predictions of a nonlinear, laterally averaged layer model forced by a mean flow and sea level at the boundaries. Since neither the vertical structure of the principal tidal constituent nor the pattern of horizontal variation of the largest overtides can be explained using well established models, we conclude that they are fundamentally inadequate and should no longer be used for more than a basic qualitative understanding, and even then should be used with caution. We provide comprehensive tables of the tidal current parameters to facilitate the critical evaluation of future models of the circulation in the Sound

World Health Organization Generic Protocol to Assess Drug-Resistant HIV Among Children <18 Months of Age and Newly Diagnosed With HIV in Resource-Limited Countries

Increased use of nonnucleoside reverse transcriptase inhibitors (NNRTIs) in pregnant and breastfeeding women will result in fewer children infected with human immunodeficiency virus (HIV). However, among children infected despite prevention of mother-to-child transmission (PMTCT), a substantial proportion will acquire NNRTI-resistant HIV, potentially compromising response to NNRTI-based antiretroviral therapy (ART). In countries scaling up PMTCT and pediatric ART programs, it is crucial to assess the proportion of young children with drug-resistant HIV to improve health outcomes and support national and global decision making on optimal selection of pediatric first-line ART. This article summarizes a new World Health Organization surveillance protocol to assess resistance using remnant dried blood spot specimens from a representative sample of children aged <18 months being tested for early infant diagnosi

A Retrospective Survey of HIV Drug Resistance Among Patients 1 Year After Initiation of Antiretroviral Therapy at 4 Clinics in Malawi

In 2004, Malawi began scaling up its national antiretroviral therapy (ART) program. Because of limited treatment options, population-level surveillance of acquired human immunodeficiency virus drug resistance (HIVDR) is critical to ensuring long-term treatment success. The World Health Organization target for clinic-level HIVDR prevention at 12 months after ART initiation is ≥ 70%. In 2007, viral load and HIVDR genotyping was performed in a retrospective cohort of 596 patients at 4 ART clinics. Overall, HIVDR prevention (using viral load ≤ 400 copies/mL) was 72% (95% confidence interval [CI], 67%-77%; range by site, 60%-83%) and detected HIVDR was 3.4% (95% CI, 1.8%-5.8%; range by site, 2.5%-4.7%). Results demonstrate virological suppression and HIVDR consistent with previous reports from sub-Saharan Africa. High rates of attrition because of loss to follow-up were noted and merit attention

Burns and Scalds Assessment Template:Standardising clinical assessment of childhood burns in the Emergency Department

Objectives The Burns and Scalds Assessment Template (BaSAT) is an evidence-based proforma coproduced by researchers and ED staff with the aim of (1) standardising the assessment of children attending ED with a burn, (2) improving documentation and (3) screening for child maltreatment. This study aimed to test whether the BaSAT improved documentation of clinical, contributory and causal factors of children’s burns. Methods A retrospective before-and-after study compared the extent to which information was recorded for 37 data fields after the BaSAT was introduced in one paediatric ED. Pre-BaSAT, a convenience sample of 50 patient records of children who had a burn was obtained from the hospital electronic database of 2007. The post-BaSAT sample included 50 randomly selected case notes from 2016/2017 that were part of another research project. Fisher's exact test and Mann-Whitney U tests were conducted to test for statistical significance. Results Pre-BaSAT, documentation of key data fields was poor. Post-BaSAT, this varied less between patients, and median completeness significantly (p<0.001) increased from 44% (IQR 4%–94%) to 96% (IQR 94%–100%). Information on ‘screening for maltreatment, referrals to social care and outcome’ was poorly recorded pre-BaSAT (median of 4% completed fields) and showed the greatest overall improvement (to 95%, p<0.001). Documentation of domestic violence at home and child’s ethnicity improved significantly (p<0.001) post-BaSAT; however, these were still not recorded in 36% and 56% of cases, respectively. Conclusion Introduction of the BaSAT significantly improved and standardised the key clinical data routinely recorded for children attending ED with a burn

HIV Drug Resistance Early Warning Indicators in Cohorts of Individuals Starting Antiretroviral Therapy Between 2004 and 2009: World Health Organization Global Report From 50 Countries

The World Health Organization developed a set of human immunodeficiency virus drug resistance (HIVDR) early warning indicators (EWIs) to assess antiretroviral therapy clinic and program factors associated with HIVDR. EWIs are monitored by abstracting data routinely recorded in clinical records, and the results enable clinics and program managers to identify problems that should be addressed to minimize preventable emergence of HIVDR in clinic populations. As of June 2011, 50 countries monitored EWIs, covering 131 686 patients initiating antiretroviral treatment between 2004 and 2009 at 2107 clinics. HIVDR prevention is associated with patient care (appropriate prescribing and patient monitoring), patient behavior (adherence), and clinic/program management efforts to reduce treatment interruptions (follow up, retention on first-line ART, procurement and supply management of antiretroviral drugs). EWIs measure these factors and the results have been used to optimize patient and population treatment outcome