A Multi-Level Fit-Based Quality Improvement Initiative to Improve Colorectal Cancer Screening in a Managed Care Population.

IntroductionColorectal cancer (CRC) is a common but largely preventable disease with suboptimal screening rates despite national guidelines to screen individuals age 50-75. Single-component interventions aimed to improve screening uptake only modestly improve rates; data suggest that multi-modal approaches may be more effective.MethodsWe designed, implemented, and evaluated the impact of a multi-modal intervention on CRC screening uptake among unscreened patients in a large managed care population. Patient-level components included a mailed letter with education about screening options and pre-colonoscopy telephone counseling. For providers, we facilitated communication of screening test results and work-flow for abnormal results. System-level modifications included establishment of a patient navigator, expedited work-up for abnormal results, and stream-lined colonoscopy scheduling. We measured the rate of screening uptake overall, screening uptake by modality, change in the proportion of the population screened, and positive fecal immunochemical test (FIT) follow-up rates in the 1-year study period.ResultsThere were 5093 patients in the intervention cohort. Of these, 33.2% participated in FIT or colonoscopy screening within 1 year of the mailing. A total of 1078 (21.2%) participants completed a FIT and 611 (12.0%) completed a screening colonoscopy. The screening rate in the managed care population increased from 65.1 to 76.6%. Fifty-nine patients (5.5%) had a positive FIT, of which 30 (50.8%) completed a diagnostic colonoscopy.ConclusionMulti-modal interventions can result in substantial improvement in CRC screening uptake in large and diverse managed care populations.Translational impactHealth systems should shift their focus from single-level to multi-level interventions when addressing barriers to CRC screening

Longitudinal stability augmentation of seaplanes in planing

The towing tank experiments conducted at Yokohama National University from November 30 to December 9 in 2005 suggested a new way of suppressing a dangerous coupled motion between heave and pitch called porpoising. The research in this paper was developed on the observations made in the experiments and conducted numerical simulations to further investigate the parametric design space. Two linear-time-invariant models were developed: rigid-body planing craft (conventional float planes or flying boats), and flexibly supported planing craft. The latter could simulate the new method found in the experiments for suppressing porpoising. In this study, the stability of the oscillatory motions was analyzed to see the effect of design variables on the inception of porpoising. The parametric study of flexibly supported float planes in the context of porpoising was a new contribution in the conceptual design of seaplanes

On defining the Hamiltonian beyond quantum theory

Energy is a crucial concept within classical and quantum physics. An essential tool to quantify energy is the Hamiltonian. Here, we consider how to define a Hamiltonian in general probabilistic theories, a framework in which quantum theory is a special case. We list desiderata which the definition should meet. For 3-dimensional systems, we provide a fully-defined recipe which satisfies these desiderata. We discuss the higher dimensional case where some freedom of choice is left remaining. We apply the definition to example toy theories, and discuss how the quantum notion of time evolution as a phase between energy eigenstates generalises to other theories.Comment: Authors' accepted manuscript for inclusion in the Foundations of Physics topical collection on Foundational Aspects of Quantum Informatio

Race and sex: teachers' views on who gets ahead in schools?

The research reported here was part of a large study of the impact of age, disability, race and sex on the teaching profession in England. The basic question asked in this research was how do these factors interact with career aspirations and achievements of classteachers, promoted teachers and headteachers? There were three different data sources: a large postal survey drawn from diverse geographic regions across England with over 2000 respondents; face‐to‐face individual interviews with over 100 teachers in 18 case study schools from across all of the main regions of England; discussions with special interest groups of teachers. Not surprisingly, the answer to the above question was complex. Nonetheless, the paper's conclusion highlights some of the noteworthy themes across this broad sample of teachers from primary, secondary and special schools

Aluminum-, Calcium- And Titanium-Rich Oxide Stardust In Ordinary Chondrite Meteorites

We report isotopic data for a total of 96 presolar oxide grains found in residues of several unequilibrated ordinary chondrite meteorites. Identified grain types include Al2O3, MgAl2O4, hibonite (CaAl12O19) and Ti oxide. This work greatly increases the presolar hibonite database, and is the first report of presolar Ti oxide. O-isotopic compositions of the grains span previously observed ranges and indicate an origin in red giant and asymptotic giant branch (AGB) stars of low mass (<2.5 MSun) for most grains. Cool bottom processing in the parent AGB stars is required to explain isotopic compositions of many grains. Potassium-41 enrichments in hibonite grains are attributable to in situ decay of now-extinct 41Ca. Inferred initial 41Ca/40Ca ratios are in good agreement with model predictions for low-mass AGB star envelopes, provided that ionization suppresses 41Ca decay. Stable Mg and Ca isotopic ratios of most of the hibonite grains reflect primarily the initial compositions of the parent stars and are generally consistent with expectations for Galactic chemical evolution, but require some local interstellar chemical inhomogeneity. Very high 17O/16O or 25Mg/24Mg ratios suggest an origin for some grains in binary star systems where mass transfer from an evolved companion has altered the parent star compositions. A supernova origin for the hitherto enigmatic 18O-rich Group 4 grains is strongly supported by multi-element isotopic data for two grains. The Group 4 data are consistent with an origin in a single supernova in which variable amounts of material from the deep 16O-rich interior mixed with a unique end-member mixture of the outer layers. The Ti oxide grains primarily formed in low-mass AGB stars. They are smaller and rarer than presolar Al2O3, reflecting the lower abundance of Ti than Al in AGB envelopes.Comment: Accepted for publication in ApJ; 47 pages, 13 figure

Mothers of Soldiers in Wartime: A National News Narrative

National news media represent mothers of US combat soldiers in the Iraq War as archetypal good mothers, that is, mothers who continue their maternal work even after their children are deployed. However, not all mothers are depicted as the archetypal patriotic mother, i.e., a good mother who is also stoic and silent about the war and her child\u27s role in it. Mothers of soldiers are portrayed as good mothers who sometimes also voice their attitudes about the war effort. The maternal attitudes ranged from complete support for the war to opposition to the war but support for the soldiers. The findings suggest a picture of wartime motherhood that is more nuanced than the historical image of the patriotic mother suggests

Pasts and pagan practices: moving beyond Stonehenge

Theorizing the past is not restricted to archaeology and interpretations of 'past' both influence and are themselves constituted within politicized understandings of self, community and in certain instances, spirituality. 'The past in the imagination of the present' is appropriated, variously, to give meaning to the present or to justify actions and interpret experiences. Summer solstice at Stonehenge, with an estimated 21,000 celebrants in 2005, is only the most publicized appropriation (by pagans and other adherents of alternative spirituality and partying) of a 'sacred site'; and conflicts and negotiations occurring throughout Britain are represented in popular and academic presentations of this 'icon of Britishness'. This paper presents work from the Sacred Sites, Contested Rites/Rights Project (http://www.sacredsites.org.uk) project, a collaboration of archaeology and anthropology informed by pagan and alternative approaches and standpoints investigating and theorizing discourse and practice of heritage management and pagan site users. Whether in negotiations around the Stonehenge solstice access or in dealing with numerous other sites, boundaries between groups or discourses are not clearly drawn - discursive communities merge and re-emerge. But clearly 'past' and 'site' are increasingly important within today's Britain, even as television archaeology increases its following, and pagan numbers continue to grow.</p

Low-energy quenching of positronium by helium

Very low-energy scattering of orthopositronium by helium has been investigated for simultaneous study of elastic cross section and pick-off quenching rate using a model exchange potential. The present calculational scheme, while agrees with the measured cross section of Skalsey et al, reproduces successfully the parameter ^ 1Z_{\makebox{eff}}, the effective number of electrons per atom in a singlet state relative to the positron. Together with the fact that this model potential also leads to an agreement with measured medium energy cross sections of this system, this study seems to resolve the long-standing discrepancy at low energies among different theoretical calculations and experimental measurements.Comment: 4 latex pages, 3 postscript figure