Federally Qualified Health Centers in a Changing Health Care Environment: Are They Prepared for the Challenge?

In many communities access to primary care is absent, unaffordable, or otherwise inaccessible despite ever increasing demand. Since 1965, Federally Qualified Health Centers (FQHC) have acted as principle providers of primary care for those living in communities lacking adequate access. As of 2013, there were 1,202 FQHCs serving 21.7 million patients, of whom 93% were below 200% of the federal poverty line, 35% were uninsured, 62% were racial/ethnic minorities, 4% were migrants, and 23% were best served in a non-English language. Recently FQHCs received substantial financial support through the American Relief and Recovery Act of 2009 (ARRA), and the Patient Protection and Affordable Care Act of 2010 (ACA). ARRA provided more than $2 billion and ACA provides$11 billion directly to FQHCs for ongoing operations, new service sites, and expanded services. Several additional ACA provisions are expected to bolster the ability of FQHCs to accommodate new demand, while adding and expanding still needed services. Immediately playing the pivotal role expected of them in accommodating the anticipated increase in demand for primary healthcare will be challenging for FQHCs as they also adapt to new organizational structures and payment systems. This dissertation examines the ability of FQHCs to provide primary care services in a changing healthcare environment by evaluating the impact of the recession, ARRA, and ACA on: (1) the demographic and health composition of patients served by FQHCs; (2) the capacity of FQHCs to provide primary care services, and (3) the ability to accommodate the expected increase in demand. Lastly, this work examines the remaining challenges and the implications of those challenges for the future of the FQHC program.PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/135787/1/jwillem_1.pd

Pile Driving Criteria for Construction Near an Historic Dam

The construction of a new road included a bridge crossing a river. The location of the bridge crossing was about 300 feet (91.5 meters) downstream from an historic dam. Prior to construction, concerns were raised about vibrations which might be generated from construction activities, especially pile driving for the new bridge abutments, and their potential effect on the integrity of the dam. As a result, a vibration study was conducted on the dam, prior to construction, to assess the vibrations generated from normal operation of the dam and from a simulated pile driving operation. Based on the simulated pile driving activity, a recommendation was made for limiting the pile driving energy, which was implemented during construction. A follow-up vibration study was conducted in the field during construction to both monitor the vibrations transmitted to the dam and adjust pile driving operations (if needed); and to confirm the data collected from the previous investigation

Teaching and learning in community: a phenomenological study of community college faculty pedagogy and learning communities

This study explored whether faculty/student collaboration in learning communities can help fulfill faculty members\u27 professional developmental needs, and if so, how these teaching experiences in learning communities benefit the faculty and their institution. The research sought to discover if faculty perceived that they experienced rejuvenation because of their participation in learning communities, and as a result of this rejuvenation, did they perceive that they had altered their pedagogy. And finally, the study investigated whether or not faculty perceived if their participation in learning communities affected their stand-alone classes and other college responsibilities such as committee work. This qualitative inquiry used an in-depth phenomenological interview process to seek the data. Six participants from a metropolitan community college in the Southwest were each interviewed three times. The first interview was a life story interview, which focused on teaching careers in general. The second interview asked each to reflect specifically on their learning community teaching experiences, and in the third interview, each was given the opportunity to make meaning from all teaching experiences and indicate if they felt learning communities had affected pedagogy and participation in college activities and responsibilities. The analysis of the transcribed interviews revealed the following themes: a passion for teaching; strong and positive attitudes about students; the importance of learning communities in their teaching experiences; a metaphor about marriage and their teaching partners; the multiple ways their pedagogy had been altered; the need for flexibility if participating in learning communities; and multiple types of faculty benefits, such as how faculty learn more when teaching with a partner, how they use collaboration, and how learning communities provide significant opportunities for faculty development. This study suggests that institutions contemplating starting learning community initiatives or alternative methods for faculty development would benefit from reading the rich descriptions embedded in the participants\u27 stories. Finally, the study offers the rationale for beginning a learning community initiative because faculty and the institution have opportunities to gain significant benefits, such as synergy, a more creative faculty, and a faculty who are more willing to participate in additional academic responsibilities

Ground Improvement for Redevelopment of Former Landfill

A former industrial landfill site was selected for the design and construction of a large industrial building. Due to the soil and groundwater conditions along with potential environmental impacts discussed in this paper, support of the building using shallow spread foundations or conventional deep foundations, such as driven or cast-in-place piles or drilled piers were not considered to be reasonable foundation support alternatives. Therefore, ground improvement was deemed the best alternative to support the building, floor slabs and machine foundations for the project, although timber piles with a structural slab were also considered. Controlled modulus columns and rammed aggregate piers were the two options considered feasible for the project since these two methods would generate little to no soil cuttings or groundwater at the ground surface requiring special handling and disposal to a regulated landfill. Controlled modulus columns were ultimately selected by the Owner and designed for vertical compression and uplift loading conditions for the building and for support of machine foundations and floor slabs

Drilled Pier Load Capacity of Detroit Area Hardpan Using an Overberg Load Cell

Supplemental geotechnical investigations were conducted on two Detroit area projects with the purpose of optimizing design criteria for proposed drilled pier foundations. For both projects, the major effort involved the formulation, implementation and interpretation of a load test using an Osterberg load cell rather than conventional dead weight or reaction piers. Load and settlement trends were monitored with a series of strain gauges and telltales. Field data are presented in graphical form to illustrate the results of the load tests

Housing and equipment for growing and finishing hogs

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Searching for Neutron-Proton Equilibration at Fermi Energies

The density dependence of the symmetry term of the nuclear Equation of State (nEoS) has been studied using reactions of 70Zn+70Zn, 64Zn+64Zn and 64Ni+64Ni at 35 MeV/nucleon. The experiment was performed using the NIMROD (Neutron-Ion Multidetector for Reaction Oriented Dynamics), which is a 4π charged-particle array housed inside the TAMU Neutron Ball. The detector was chosen due to its fantastic isotopic resolution and large angular coverage. Neutron-proton (NZ) equilibration between the two largest fragments originating from the excited projectile-like fragment was used as a probe to study the density dependence of the nEoS. The NZ equilibration was observed to be exponentially decreasing for the second heaviest fragment and exponentially increasing for the heaviest fragment. A mean equilibration lifetime of 0.3 zs was extracted for the heaviest and second heaviest fragments in all three reaction systems. The results were compared to the Constrained Molecular Dynamics (COMD) and Anti-symmetrized Molecular Dynamics (AMD) models in conjunction with the GEMINI statistical model. The results suggest a soft density dependence of the asymmetry energy term. Additionally, the NIMROD array and the Neutron Ball were recommissioned and upgraded. New detectors were tested, characterized and implemented. The results from the Neutron Ball indicate the background is approximately 1.5 neutrons lower per event than previously measured results

Handling hog manure as a liquid

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