Evaluating the Patient-Centeredness of Medicare Part D

The implementation of the Medicare prescription drug benefit: Part D ) has brought about many changes in the provision of prescription medications to adults with serious mental illness. Existing research on the impact of Part D on this population, for the most part, examines the benefit from the perspective of the physicians who treat these individuals. This research seeks to use a framework of patient-centered care to examine the impact of the Part D benefit on adults with mental illness, from the viewpoints of beneficiaries themselves and the case managers: community support workers ) who serve them. In addition, data from the Medicare Web site and the Centers for Medicare and Medicaid Services are used to examine the patient-centered characteristics of the Part D program. The Medicare prescription drug benefit is meeting the needs of adults with serious mental illness, but this is largely because of the assistance that beneficiaries receive from community professionals. The Medicare Part D program meets some expectations of a patient-centered program, but there are also definite areas for improvement, such as involvement of patients and information and education for beneficiaries

Lead 17: Leadership Engineering and Design Program A Professional Development Series for Assistant Principals Aspiring to the Principalship

A capstone submitted in partial fulfillment of the requirements for the degree of Doctor of Education in the Ernst and Sara Lane Volgenau College of Education at Morehead State University by Melissa D. Hensley on February 9, 2021

Relationships Between Teacher Attendance and Student Scores on the Tennessee Comprehensive Assessment Program Achievement Test in East Tennessee.

This mixed methods study examined relationships between third, fourth, and fifth grade teacher attendance as well as teacher and administrator perceptions of teacher attendance during the 2005-06, 2006-07, and 2007-08 school years. Third, fourth, and fifth grade student test scores on the Tennessee Comprehensive Assessment Program (TCAP) Achievement test given in the spring of 2006, 2007, and 2008 were also examined. TCAP score data for this study were gathered electronically, with published data from the Tennessee Department of Education. Teacher attendance records were collected using Siesta, a teacher attendance tracking program. Teacher and administrator perceptions were gathered through surveys, interviews, and focus groups. The population for this study included five K-5 schools and two K-8 schools in a small, rural, public school system in Tennessee. All students in grades 3 through 8 take the TCAP test each spring. Students must take a total of 4 subtests. Quantitative variables were analyzed using descriptive statistics including t tests, analysis of variance (ANOVA), Mann Whitney U, and Pearson correlations. Qualitative data including interviews, focus groups, surveys, documents, handbooks, and school calendars were analyzed to better understand teacher and administrator perceptions about teacher absences. The results of this study were mixed. Teachers and administrators who participated in this study agreed that teacher absences do affect student test scores, but the quantitative data did not support this. The null hypotheses were retained in all courses and grades except third grade Math. This means there was no relationship between teacher absences and student test scores

Evaluating the use of high-fidelity simulators during mock neonatal resuscitation scenarios in trying to improve confidence in residents

Objective: The purpose of this study was to investigate the effect of the use of high-fidelity simulators with multidisciplinary teaching on self-reported confidence in residents. Methods: A total of 26 residents participated in a session led by a pediatric faculty member and a Neonatal Intensive Care Unit transport nurse using a high-fidelity pediatric simulator. Multiple scenarios were presented and each resident took turns in various roles. Pre-intervention surveys based on a 5-point Likert-type scale were given before the scenarios and were compared to the results of identical post-intervention surveys. Results: Statistically significant (p \u3c 0.05) pre to post gains for self-confidence were observed. Improvements in confidence were analyzed using the mean difference. The largest improvement in confidence was seen in the ability to treat neonatal respiratory arrest. This was followed by the ability to supervise/run a code, and the ability to place an umbilical venous catheter. Conclusion: These results revealed that high-fidelity simulation-based training has significant positive gains in residents’ self-reported confidence

Threatened and Endangered Species Survey for Patrick Air Force Base, Florida

A review of previous environmental work conducted at Patrick Air Force Base (PAFB) indicated that several threatened, endangered, or species of special concern occurred or had the potential to occur there. This study was implemented to collect more information on protected species at PAFB. A map of landcover types was prepared for PAFB using aerial photography, groundtruthing, and a geographic information system (GIS). Herbaceous vegetation was the most common vegetation type. The second most abundant vegetation type was disturbed shrubs/exotics. The beach and associated dune vegetation comprised 3.2% of the land area, but was the most extensive natural community within PAFB. A few isolated mangrove communities exist along the Banana River. Seventy-seven species of vascular plants occurred on the dunes, including four species listed by state agencies: spider lily (Hymenocallis latifolia), prickly pear cactus (Opuntia stricta), beach star (Remirea maritima), and inkberry (Scaevola plumien). Surveys of other habitats revealed eighty-four species of vascular plants including two state-listed species: spider lily and prickly pear cactus. Many of these areas are dominated by invasive, exotic species, particularly Brazilian pepper (Schinus terebinthifolius) and Australian pine (Casuarina equisetifolia), and native species of open or disturbed sites such as camphorweed (Heterotheca subaxillaris) and beardgrass (Andropogon spp.). Due to the isolation of PAFB from other natural areas, most exotic plant populations on the base are not an immediate threat to intact native plant communities. Dune habitat was surveyed for the southeastem beach mouse (Peromyscus polionotus niveiventris) by quarterly trapping along eight 100 m transects. No beach mice were found. The limited extent of dune habitat, its fragmented condition, and the isolation of PAFB from extant populations of the beach mouse probably accounts for its absence. Surveys of birds on PAFB found an avifauna characteristic of species that occur in the Indian River Lagoon system. Twenty-five species of waterbirds were observed during quarterly surveys on PAFB, including five species listed as species of special concern by the state of Florida: Snowy Egret (Egretta thula), Little Blue Heron (Egretta caerulea), Tricolored Heron (Egretta tricolo4, White Ibis (Eudocimus albus), and Brown Pelican (Pelecanus occidentalis). The Golf Course was used extensively by almost all species of waterbirds on PAFB. Twenty-two species of shorebirds were observed on PAFB. Although no listed species were observed, the potential exists for several protected species of shorebirds to use the beach at PAFB during some parts of the year. The Airfield runways and associated grass areas were important sites at PAFB for loafing and feeding for some shorebirds. Surveys of rooftop nesting by Least Terns (Stema antillarum) on PAFB found a large colony on a rooftop in the PAFB Industrial Area. This colony produced some independent young. Two rooftop Least Tern colonies reported from previous years were inactive during 1996. A small number of Black Skimmers (Rhynchops nigee attempted to nest at the Least Ten colony but were unsuccessful. Surveys for the gopher tortoise (Gopherus polyphemus) revealed burrows and tortoises only at the Waste Study Site; five burrows and three tortoises were observed. No Florida scrub lizards (Sceloporus woodi), eastern indigo snakes (Drymarchon corais couperl), or diamondback terrapins (Malademys terrapin terrapin) were observed. American alligators (Alligator mississippiensis) were observed on the Golf Course and using ditches, ponds, and areas along the Banana River. The amount of dune habitat could be expanded by not mowing areas adjacent to the dunes to allow dune species to colonize and expand. Planting dune species as part of the beach renourishment project will also increase this habitat. Exotic plants dominate several areas on the base and are used by threatened, endangered, and species of special concern. However, the use of native vegetation in landscaping projects throughout the base would improve habitat for wildlife, and invasive, exotic plants should not be used in any horticultural plantings. Water quality of ponds, ditches, and canals is important for waterbirds; it should be maintained and protected from contamination. Nesting Least Terns are sensitive to disturbance; rooftops used for nesting should be protected from disturbance. Monitoring of Least Tern and Black Skimmer nesting should be continued to determine what roofs are being used and whether nesting is successful. Furthermore, based on the large numbers of waterbirds observed on PAFB, continued monitoring of them is recommended

Environmental Conditions and Threatened and Endangered Species Populations near the Titan, Atlas, and Delta Launch Complexes, Cape Canaveral Air Station

Launches of Delta, Atlas, and Titan rockets from Cape Canaveral Air Station (CCAS) have potential environmental effects. These could occur from direct impacts of launches or indirectly from habitat alterations. This report summarizes a three-year study (1 995-1 998) characterizing the environment, with particular attention to threatened and endangered species, near Delta, Atlas, and Titan launch facilities. Cape Canaveral has been modified by Air Force development and by 50 years of fire suppression. The dominant vegetation type around the Delta and Atlas launch complexes is coastal oak hammock forest. Oak scrub is the predominant upland vegetation type near the Titan launch complexes. Compositionally, these are coastal scrub communities that has been unburned for > 40 years and have developed into closed canopy, low-stature forests. Herbaceous vegetation around active and inactive facilities, coastal strand and dune vegetation near the Atlantic Ocean, and exotic vegetation in disturbed areas are common. Marsh and estuarine vegetation is most common west of the Titan complexes. Launch effects to vegetation include scorch, acid, and particulate deposition. Discernable, cumulative effects are limited to small areas near the launch complexes. Water quality samples were collected at the Titan, Atlas, and Delta launch complexes in September 1995 (wet season) and January 1996 (dry season). Samples were analyzed for heavy metals, chloride, total organic carbon, calcium, iron, magnesium, sodium, total alkalinity, pH, and conductivity. Differences between fresh, brackish, and saline surface waters were evident. The natural buffering capacity of the environment surrounding the CCAS launch complexes is adequate for neutralizing acid deposition in rainfall and launch deposition. Populations of the Florida Scrub-Jay (Aphelocoma coerulescens), a Federally-listed, threatened species, reside near the launch complexes. Thirty-seven to forty-one scrub-jay territories were located at Titan, Atlas, and Delta launch complexes between 1995 and 1997. No direct impacts to scrub-jays were observed as a result of normal launches. The explosion of the Delta rocket in January 1997 caused direct impacts to the habitat of several scrub-jays families, from fire and debris; however, no scrub-jay mortality was observed. Mortality exceeded reproductive output at all areas over the course of the study. Populations of the southeastern beach mouse (Peromyscus polionotus niveiventris) populations, a Federally listed, threatened species, reside near all the launch complexes. Hurricane Erin and several other tropical storms impacted several areas at the inception of the study in 1995 causing coastal habitat alterations as a result of salt-water intrusion. Both the habitat and the beach mice populations recovered during the course of the study. No direct impacts to southeastern beach mice were observed as a result of normal launch operations. Direct impacts were observed to the habitat as a result of the explosion of the Delta rocket in January 1997. This alteration of the habitat resulted in a shift in use with the mice moving on to the newly burned part of the site. Waterbirds use wetlands and aquatic systems near the launch complexes. Species include the Federally-listed, endangered Wood Stork (Mycferia americana) and several state-listed species of special concern including the Snowy Egret (Egretfa thula fhula), Reddish Egret (Egreffa rufescens rufescens), White Ibis (Eudocimus albus), Roseate Spoonbill (Ajaia ajaja), Tricolored Heron (Egreffa tricolor ruficolis), and Little Blue Heron (Egreffa caerulea). No impacts to these populations resulting from any launch operations were observed. Gopher tortoises (Gopherus polyphemus) also occur around the launch complexes. Most of those observed appeared to be in good condition; however, upper respiratory tract disease is known to occur in the population. Cape Canaveral Air Station, including areas near active launch colexes, remains important habitat for a variety of native plants and animals including threatened and endangered species. Direct negative effects of current launch systems appear limited. Additional monitoring of these populations and habitats is required to determine if subtle, long-term changes are occurring, to determine if new launch systems and facilities cause other effects, and to determine the effects of habitat restoration and management

Monitoring Direct Effects of Delta, Atlas, and Titan Launches from Cape Canaveral Air Station

Launches of Delta, Atlas, and Titan rockets from Cape Canaveral Air Station (CCAS) have potential environmental effects that could arise from direct impacts of the launch exhaust (e.g., blast, heat), deposition of exhaust products of the solid rocket motors (hydrogen chloride, aluminum oxide), or other effects such as noise. Here we: 1) review previous reports, environmental assessments, and environmental impact statements for Delta, Atlas, and Titan vehicles and pad areas to clarity the magnitude of potential impacts; 2) summarize observed effects of 15 Delta, 22 Atlas, and 8 Titan launches; and 3) develop a spatial database of the distribution of effects from individual launches and cumulative effects of launches. The review of previous studies indicated that impacts from these launches can occur from the launch exhaust heat, deposition of exhaust products from the solid rocket motors, and noise. The principal effluents from solid rocket motors are hydrogen chloride (HCl), aluminum oxide (Al2O3), water (H2O), hydrogen (H2), carbon monoxide (CO), and carbon dioxide (CO2). The exhaust plume interacts with the launch complex structure and water deluge system to generate a launch cloud. Fall out or rain out of material from this cloud can produce localized effects from acid or particulate deposition. Delta, Atlas, and Titan launch vehicles differ in the number and size of solid rocket boosters and in the amount of deluge water used. All are smaller and use less water than the Space Shuttle. Acid deposition can cause damage to plants and animals exposed to it, acidify surface water and soil, and cause long-term changes to community composition and structure from repeated exposure. The magnitude of these effects depends on the intensity and frequency of acid deposition

Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies

Harnessing the NEON data revolution to advance open environmental science with a diverse and data-capable community

It is a critical time to reflect on the National Ecological Observatory Network (NEON) science to date as well as envision what research can be done right now with NEON (and other) data and what training is needed to enable a diverse user community. NEON became fully operational in May 2019 and has pivoted from planning and construction to operation and maintenance. In this overview, the history of and foundational thinking around NEON are discussed. A framework of open science is described with a discussion of how NEON can be situated as part of a larger data constellation—across existing networks and different suites of ecological measurements and sensors. Next, a synthesis of early NEON science, based on >100 existing publications, funded proposal efforts, and emergent science at the very first NEON Science Summit (hosted by Earth Lab at the University of Colorado Boulder in October 2019) is provided. Key questions that the ecology community will address with NEON data in the next 10 yr are outlined, from understanding drivers of biodiversity across spatial and temporal scales to defining complex feedback mechanisms in human–environmental systems. Last, the essential elements needed to engage and support a diverse and inclusive NEON user community are highlighted: training resources and tools that are openly available, funding for broad community engagement initiatives, and a mechanism to share and advertise those opportunities. NEON users require both the skills to work with NEON data and the ecological or environmental science domain knowledge to understand and interpret them. This paper synthesizes early directions in the community’s use of NEON data, and opportunities for the next 10 yr of NEON operations in emergent science themes, open science best practices, education and training, and community building

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570