Strategy Design Amid Complexity: Tools for Designing and Implementing Adaptive Funding Strategies

Increasingly, foundations recognize the importance of designing adaptive strategies that can respond to complex environments and problems. Recent articles have cautioned against practices common in strategic philanthropy that hinder the ability of foundations and grantees to account for changing contexts and adapt their strategies accordingly. But understanding the importance of and barriers to adaptive strategy is not sufficient. Foundations now need processes and tools to create and implement adaptive strategies while also addressing the core dilemmas such strategies create: managing accountability in the context of adaptation, adapting at the right level, and responding to changes in context without creating too much instability for grantees. Using a case study from the Colorado Health Foundation\u27s advocacy funding strategy to increase health care coverage, this article presents a set of tools to help foundations design adaptive strategies and ideas for balancing accountability for achieving goals with adaptability throughout the course of an initiative

The effect of stress on the initial onset and relapse rate of multiple sclerosis

Due to the character of the original source materials and the nature of batch digitization, quality control issues may be present in this document. Please report any quality issues you encounter to [email protected], referencing the URI of the item.Includes bibliographical references (leaves 50-52).Over 400,000 Americans have multiple sclerosis (MS) and doctors can not discover the cause of the disease or how to stop the progressive deterioration. The symptoms of MS are caused by destruction of the myelin sheath, in which the nerve pathways are disrupted and problems with movement, sensation or vision can occur. One environmental factor, stress, has been hypothesized to be a contributor to the onset of MS and one of many factors controlling the commonly occurring flare-ups of symptoms, or relapses. I have completed retrospective and progressive survey work with MS patients to evaluate the level of stress in their lives prior to the initial onset and the recurring relapses. Two main hypotheses guided this research. First, a high percentage of MS patients perceived that stress was present in their life prior to symptom onset. Second, a high percentage of MS patients experienced relapses during or immediately following moments of stress. Members of a regional MS Society were randomly selected to participate in this study. Each participant was sent a questionnaire to analyze stressful life events present in the year prior to symptom onset and results showed that there was a high incidence (88.6%) of stressful life events prior to symptom onset in this population. The majority of the research was focused on the progressive study to test for a correlation between stress and the relapse rate, as seen in a change in capacity levels of certain functions commonly affected by multiple sclerosis. Each participant was sent the same questionnaire three times over a course of 18 weeks. The questionnaire consisted of five parts, asking questions in regard to social support, stressful life events, perceived stress, incapacity levels from the Kurtske scale and different ways of coping with MS. There was no significant correlation between stress levels and incapacity levels in this population of MS patients. Most patients perceived that their stress levels, social support levels and coping techniques stayed constant over the 18-week time period, and therefore, none of these had an influence on buffering the effect of stress on the incapacity levels

Use of the Montreal Cognitive Assessment (MoCA) in a Rural Outreach Program for Military Veterans

The Montreal Cognitive Assessment (MoCA) is a free, easily accessible screener ideal for rural areas where resources are limited. We examined administration and scoring by Veteran Community Outreach Health Workers (VCOHWs); compared positive screening rates using two cutoff scores; and examined predictors of education-adjusted scores in N = 168 rural military Veterans from the Alabama Veteran Rural Health Initiative. Accuracy of administration (95 percent) and scoring (68 percent) was calculated and recommendations are offered. Higher than expected rates of positive screens were observed (40 percent using 24/30 cutoff) in this relatively young (M = 55 years) community-dwelling sample. Age, education, and race but not subjective health predicted differences in domain and total education-adjusted scores on multivariate and univariate tests. This study advances social science research in rural communities by being the first to: (1) examine MoCA scores in a rural, Deep South U.S. sample; and (2) report fidelity administration data for VCOHWs

momHealth: A Feasibility Study of a Multi-behavioral Health Intervention for Pregnant and Parenting Adolescent Mothers

Introduction. In 2016, 209,809 babies were born to mothers 15 -19 years of age, for a live birth rate of 20.3 per 1,000 in this age group. Many health issues surround adolescent mothers and their infants, many  which can be addressed through behavioral change. We examined feasibility and acceptability of momHealth, a Multiple Health Behavior Change (MHBC) intervention focused on breastfeeding, healthy eating/active living, and depression prevention among pregnant and parenting adolescents. Methods. We used a one-group quasi-experimental longitudinal design. Nine iPad-delivered education modules, text messaging, and virtual group and individual support were provided for 12 weeks, beginning at 32 weeks of pregnancy with follow-up to 3 months postpartum. Data were collected at three home visits and ten postpartum weekly and biweekly online surveys. Results. Although recruitment and attrition presented challenges, six participants enrolled; all were pregnant with their first child, single, and had a mean age of 17.7 years (SD = 1.4). Intervention participation ranged from 59% to 91% for intervention components and three peer support groups were held. Intervention feasibility was supported by reports of clear and relevant content, reasonable time burden, iPad ease of use, and acceptable intervention length. Data collection was reported as convenient and non-burdensome, but diet recalls and activity monitoring challenged some.    Conclusions. This was the first MHBC research in adolescent pregnant women to improve breastfeeding outcomes, healthy eating/active living, and depression prevention. Findings demonstrated strengths and challenges of the interventions and methods, support feasibility and acceptability of momhealth, and informed a pilot randomized trial.

Analytical Evaluation of Drop Tests Performed on Nine 18-Inch Diameter Standardized DOE Spent Nuclear Fuel Canisters

During fiscal year 1999, a total of nine 18-inch diameter test canisters were fabricated at the Idaho National Engineering & Environmental Laboratory (INEEL) to represent the standardized Department of Energy (DOE) Spent Nuclear Fuel (SNF) canister design. Various "worst case" internal loadings were incorporated. Seven of the test canisters were 15-foot long and weighed approximately 6000 pounds, while two were 10-foot long and weighed 3000 and 3800 pounds. Seven of the test canisters were dropped from thirty feet onto an essentially unyielding flat surface and one of the test canisters was dropped from 40-inches onto a 6-inch diameter puncture post. The final test canister was dropped from 24 inches onto a 2-inch thick vertically oriented steel plate, and then tipped over to impact another 2-inch thick vertically oriented steel plate. This last test was attempting to represent a canister dropping onto another larger container such as a repository disposal container. All drop testing was performed at Sandia National Laboratory (SNL). The nine test canisters experienced varying degrees of damage to their skirts, lifting rings, and pressure boundary components (heads and main body). However, all of the canisters were shown to have maintained their pressure boundary (through pressure testing), and the four worst damaged canisters were also shown to be leaktight (via helium leak testing performed at the INEEL). Pre-drop and post-drop test canister finite element modeling was performed at the INEEL in support of the canister drop test program. All model evaluations were performed using the ABAQUS/Explicit software. The finite element models representing the test canisters accurately (though at times, slightly conservatively) predicted the actual test canister responses during the defined drop events.This paper will discuss highlights of the drop testing program and will give detailed comparisons of analysis versus actual test results

A practical review of energy saving technology for ageing populations

Fuel poverty is a critical issue for a globally ageing population. Longer heating/cooling requirements combine with declining incomes to create a problem in need of urgent attention. One solution is to deploy technology to help elderly users feel informed about their energy use, and empowered to take steps to make it more cost effective and efficient. This study subjects a broad cross section of energy monitoring and home automation products to a formal ergonomic analysis. A high level task analysis was used to guide a product walk through, and a toolkit approach was used thereafter to drive out further insights. The findings reveal a number of serious usability issues which prevent these products from successfully accessing an important target demographic and associated energy saving and fuel poverty outcomes. Design principles and examples are distilled from the research to enable practitioners to translate the underlying research into high quality design-engineering solutions

Eccrine Porocarcinoma Presenting with Unusual Clinical Manifestations: A Case Report and Review of the Literature

Eccrine porocarcinoma is a rare neoplasm that originates from the intraepidermal ductal portion of the eccrine sweat gland, and it usually occurs on the pre-existing lesion of benign eccine poroma. Its occurrence is more common in females and elderly persons. We present a case of a 44-year-old man who suffered from eccrine porocarcinoma, which developed on the right scrotum and pelvic area with metastases to the lung, adrenal gland, esophagus, ureter, and distant lymph nodes. Here we report on a unique case of eccrine porocarcinoma that developed primarily on the scrotum, which is an uncommon site, and showed rapid metastasis to the internal organs

Point discharge current measurements beneath dust devils

We document for the first time observations of point discharge currents under dust devils using a novel compact sensor deployed in summer 2016 at the USDA-ARS Jornada Experimental Range in New Mexico, USA. A consistent signature is noted in about a dozen events seen over 40 days, with a positive current ramping up towards closest approach, switching to a decaying negative current as the devil recedes. The currents, induced on a small wire about 10 cm above the ground, correlate with dust devil intensity (pressure drop) and dust loading, and reached several hundred picoAmps

A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months

Introduction: “Partners in Dementia Care” (PDC) tested the effectiveness of a care-coordination program integrating healthcare and community services and supporting veterans with dementia and their caregivers. Delivered via partnerships between Veterans Affairs medical centers and Alzheimer’s Association chapters, PDC targeted both patients and caregivers, distinguishing it from many non-pharmacological interventions. Hypotheses posited PDC would improve five veteran self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain and 5) depression. Greater impact was expected for more impaired veterans. A unique feature was self-reported research data collected from veterans with dementia. Methods and Findings: Five matched communities were study sites. Two randomly selected sites received PDC for 12 months; comparison sites received usual care. Three structured telephone interviews were completed every 6 months with veterans who could participate. Results: Of 508 consenting veterans, 333 (65.6%) completed baseline interviews. Among those who completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194 (58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had significantly less adverse outcomes than those receiving usual care, particularly for more impaired veterans after 6 months, including reduced relationship strain (B = −0.09; p = 0.05), depression (B = −0.10; p = 0.03), and unmet need (B = −0.28; p = 0.02; and B = −0.52; p = 0.08). PDC veterans also had less embarrassment about memory problems (B = −0.24; p = 0.08). At 12 months, more impaired veterans had further reductions in unmet need (B = −0.96; p < 0.01) and embarrassment (B = −0.05; p = 0.02). Limitations included use of matched comparison sites rather than within-site randomization and lack of consideration for variation within the PDC group in amounts and types of assistance provided. Conclusions: Partnerships between community and health organizations have the potential to meet the dementia-related needs and improve the psychosocial functioning of persons with dementia. Trial Registry NCT0029116

Alabama Veterans Rural Health Initiative: A Preliminary Evaluation of Unmet Health Care Needs

The Alabama Veterans Rural Health Initiative aims to better understand the health care needs, health status, and barriers to care for rural veterans. Following extensive community outreach, Veteran Community Outreach Health Workers assessed 203 veterans residing in rural counties of Alabama who either: 1) had never enrolled in VA health services, or 2) had not used those services in at least two years. While 71.4 percent of participants reported having utilized non-VHA primary care within the past year, 33.5 percent reported an inability or delay in obtaining needed health care for one or more services: primary care, specialty care, mental health care, addictions treatment, dental care, or prescription medication. The most commonly cited barrier was cost. Among all participants, 56 percent screened positive for at least one Axis I mental disorder. Rurally residing, non-VHA utilizing veterans appear to have fairly good access to primary care, but need dental care, prescription medication, and mental health care