Quality Improvement: Cervical Cancer Screening Rates within Hudson Headwaters Health Network

Nearly 8 out of every 100,000 people are diagnosed with cervical cancer each year. However, powerful screening tools exist that enable us to detect and manage cervical changes before they develop into cervical cancer. In spite of this, cervical cancer screening rates remain low for many providers. This public health project sought to identify and address a cause for low cervical cancer screening rates within the Hudson Headwaters Health Network. A literature review determined that education and mailed invitation letters were proven methods for improving cervical cancer screening rates. Following a review of the local population demographics, West Mountain Health Center within the Hudson Headwaters Health Network was targeted for a mailing campaign. The letter provided education about cervical cancer and an invitation for screening. This letter was mailed to 1075 eligible patients, with intent to compare the screening rates among patients who received this letter with screening rates among patients from previous years.https://scholarworks.uvm.edu/fmclerk/1541/thumbnail.jp

Historical Collections of the Indians in New England.

An account of the Indians of New England by Daniel Gookin, a magistrate of the Massachusetts Bay Colony. Published in 1792

Energy Expenditure in the Backcountry

The study of energy economics, known as energetics, has played a key role in shaping human ecology, evolution, and performance (Leonard & Ulijaszek, 2002). Research on energetics gives insight into how humans interact with their environment and how differences in body shape and size can impact that interaction. This understanding is particularly insightful for humans living in the backcountry for extended periods of time. Selecting food types and amounts to meet high-energy demands in the backcountry setting is a challenge, because energy demand models have primarily been based on lab studies that, in hindsight, appear to routinely underestimate energy demands on backcountry expeditions. This study examined Total Daily Energy Expenditure (TDEE) as it pertains to two to three week periods of time spent backcountry hiking, rock climbing, and skiing/camping in a winter environment. Total Daily Energy Expenditure is calculated by totaling the energy spent on basal metabolic rate, activity, thermoregulation, and Thermic Effect of Food (TEF). In total 59 participants were tested on courses with the National Outdoor Leadership School. Information from the study has been instrumental in informing the ration and nutrition practices at NOLS, as well as providing insight into other outdoor programs and backcountry users

The Importance of Trust in Outdoor Education: Exploring the Relationship between Trust in Outdoor Leaders and Developmental Outcomes

Recent studies have acknowledged the influence of the leader in the outdoor education process and have illuminated the need for strong interpersonal relationships between participants and leaders. Developing interpersonal trust is one among many ways that leaders can promote such positive interpersonal relationships between themselves and participants. Transdisciplinary literature suggests that trust in a leader can predict outcomes that are important to outdoor education. This study found a positive relationship between trust in outdoor leaders and the course outcomes of leadership development and outdoor skills development among students of National Outdoor Leadership School (NOLS) courses. Implications for program implementation and theory development are discussed

Assessing Barriers to Health Care Access for New Americans

Introduction. Healthcare within the United States has been at the forefront of public discussion and political representation in recent years, particularly as it relates to healthcare access and barriers to said access. Focus has been placed on low-income groups that most generally represent the face of the average American, but this leaves the question: How are new Americans faring, and do their struggles match those faced by the rest of the country? The new Americans of Burlington, Vermont serve as a small window into a unique refugee population’s experiences with healthcare in the United States. Methods. A focus group consisting of 8 women was hosted on-site at the Burlington Housing Authority Franklin Square apartments. Questions were designed to determine demographic data as well facilitate subjective discussion on participants’ healthcare experiences. Translation services were provided by the resident manager. Results. Languages spoken were Mai Mai, Swahili, and English. Five major themes for healthcare access barriers were identified: language barriers, having children, transportation barriers, financial barriers, and a lack of preventative care. Sub- themes were also identified, which formed a taxonomy of barriers to healthcare access among the representative population. Discussion/Conclusions. The difficulties faced by new Americans are numerous and interrelated, leading to a perpetual cycle of insufficient healthcare. Throughout the discussion, the financial burden of healthcare was regularly raised as one of the most prominent issues faced. This concern matches with those found in similar, previous studies, that have analyzed the difficulties faced by the rest of America.https://scholarworks.uvm.edu/comphp_gallery/1254/thumbnail.jp

Predictors of Perceived Development on Courses from the National Outdoor Leadership School

The purpose of this study was to examine some of the potential mechanistic variables related to participant growth and development on courses at the National Outdoor Leadership School (NOLS). The NOLS Outcome Instrument (NOI) was a retrospective pretest posttest created to measure perceived gains in six universal course outcomes targeted by NOLS courses: Communication Skills, Leadership, Expedition Behavior, Judgment in the Outdoors, Outdoor Skills, and Environmental Awareness. Participant level predictors included age, sex, previous expedition experience, and sense of personal empowerment. Course level predictors included were course length, challenge level of the course terrain, group\u27s level of functioning, and the instructors\u27 rapport with the group. Data were analyzed using Hierarchical Linear Modeling (HLM 6.0)

Absolute Calibration of a Large-diameter Light Source

A method of absolute calibration for large aperture optical systems is presented, using the example of the Pierre Auger Observatory fluorescence detectors. A 2.5 m diameter light source illuminated by an ultra--violet light emitting diode is calibrated with an overall uncertainty of 2.1 % at a wavelength of 365 nm.Comment: 15 pages, 8 figures. Submitted to JINS

Understanding the contribution of wilderness-based educational experiences to the creation of an environmental ethic in youth

The purpose of this exploratory study was to deepen our understanding of the ways in which a wilderness-based educational experience may serve as a significant life experience and how that experience may impact the development of an environmental ethic in youth. Students on 30-day courses from the National Outdoor Leadership School (NOLS) were asked to respond to the question, “Did your NOLS experience make an impact on your environmental ethics? If so, how?” The responses of 771 students indicated that a 30-day NOLS course did, in fact, positively influence both cognitive and emotional aspects of participants\u27 environmental ethics and shared some characteristics of a significant life experience. Recommendations for future research are discussed

Intermittent At-Home Suctioning of Esophageal Content for Prevention of Recurrent Aspiration Pneumonia in 4 Dogs with Megaesophagus

BACKGROUND: Megaesophagus carries a poor to guarded prognosis due to death from aspiration pneumonia. Options for medical management of regurgitation are limited to strategic oral or gastrostomy tube feeding. OBJECTIVES: To describe the use and efficacy of intermittent esophageal suctioning to prevent regurgitation and associated episodes of aspiration pneumonia in dogs with megaesophagus. ANIMALS: Four dogs with acquired idiopathic megaesophagus and recurrent aspiration pneumonia. METHODS: Retrospective review of medical records of dogs with megaesophagus in which intermittent suctioning of esophageal content was employed for management of recurrent aspiration pneumonia. RESULTS: Intermittent suctioning of the esophagus was initiated in 4 dogs after failure of strict gastrostomy tube feeding failed to prevent regurgitation and repeated episodes of aspiration pneumonia. Suctioning was accomplished by esophagostomy tube in 3 dogs and per os in 1 dog. After initiation of esophageal suctioning, dogs survived for a median of 13.5 additional months (range, 10-30 months) during which time 2 dogs had no additional episodes of aspiration pneumonia and 2 dogs had infrequent episodes of pneumonia, but aspiration was suspected to be a contributing factor in their death. Complications included clogging of the esophagostomy tube, esophagostomy site infections, and esophagitis. CONCLUSIONS AND CLINICAL IMPORTANCE: Use of intermittent esophageal suctioning in dogs with megaesophagus that continue to regurgitate despite gastrostomy tube feedings can reduce or abolish clinical episodes of aspiration pneumonia

Long-term Impacts Attributed to Participation in Adventure Education: Preliminary Findings from NOLS

One of the key issues in the field of adventure education is determining the lasting value of adventure experiences after a program ends and participants return to life at home (e.g., McAvoy, Holman, Goldenberg, Klenowsky, 2006; Wolfe & Samdahl, 2005). While anecdotal reports regarding life-changing and transformative experiences through adventure program participation are common, very few studies have examined the impacts of adventure education programs months or years . after completion. One of the main challenges of documenting and studying learning transfer in adventure education, is that most of the transfer content and contexts would be termed far transfer, which means that the content (what is transferred) and context (when and where the context is learned) of acquisition are distal from the content and context of application ( cf. Barnett & Ceci, 2002). Much of the research on transfer in outdoor education has examined the retention of targeted program outcomes after· program completion. For example, Hammitt, Freimund, Watson, Brod, and Monz (1995) examined responsible environmental behavior after program participation, and Paxton and McAvoy (2000) looked at self-efficacy development and retention six months post­-program. Few studies have examined impacts years after program completion, and those that did examine this topic commonly used interviews with small samples. One such study examined the impact of a 35-day wilderness expedition three years post-course and reported that, while some lessons from the program did not apply easily, others did, including self-awareness, respect for different others, and ability to make changes and confront challenges (Miller, 2001). In another small sample study, Gass, Garvey, and Sugarman (2003) found that wilderness orientation participants attributed outcomes of challenging previous assumptions, stronger peer relationships, and general long-term positive impacts to program participation 17 year later. Therefore, the general aim of this manuscript is to examine the potential impacts of participation in an adventure education program years after program completion through a multi-method approach and adding a quantitative approach to the typical type of inquiry of learning transfer in adventure education