Development of a Gridded Energy Analyzer for Measurement of the Mochi Experiment Ion Energy Distribution

Thesis (Master's)--University of Washington, 2015A new experiment at the University of Washington called Mochi is intended to simulate astrophysical jets in the laboratory and investigate their stability, with particular interest in conservation of canonical helicity. As a new experiment, Mochi’s plasma parameters are relatively unknown. This thesis describes the development of a gridded energy analyzer (GEA), the ultimate goal of which is to provide initial measurements of Mochi’s ion energy distribution. The concept of the Mochi.GEA is to start with the simplest possible design and make necessary improvements based on observed performance. The initial design suffered from a space charge limitation issue, which was mitigated using a pinhole aperture. Secondary electron emission was also identified as a major issue and addressed with a secondary electron suppressor. The analyzer has successfully measured the electron energy distribution but not yet successfully measured the ion energy distribution. However, the Mochi.GEA design is easily modifiable, and further development may arrive at a working design

Assessing the Impact of ʻImi Hoʻōla: A Survey Analysis of 50 Years in Advancing Healthcare Equity in Hawaiʻi and the Pacific Basin

Introduction: ʻImi Hoʻōla (IH) is a 12-month post-baccalaureate program at the John A. Burns School of Medicine that provides educational opportunities to disadvantaged premedical students with ties to Hawaiʻi and the U.S. Affiliated Pacific Islands. Its mission is to increase the number of physicians who demonstrate a strong commitment to practice in underserved communities and primary care. Since its establishment in 1973, 306 participants have completed IH. Objectives: To commemorate IH’s 50th anniversary, this study aimed to determine whether IH has worked towards its goal of improving healthcare equity in Hawaiʻi and the Pacific Basin by collecting feedback from alumni regarding the program’s impact on their careers. Methods: An electronic survey was sent to 263 IH alumni by email from April 2023 to August 2023. The survey collected data on alumni demographics, current working status including specialty, location of practice, populations served, and their perceptions of working in underserved areas before and after completing IH based on a Likert scale. The data was summarized by descriptive statistics. Results: The survey received responses from 100 IH alumni. The majority of IH alumni are practicing or training in primary care specialties such as internal medicine, family medicine, and pediatrics. For IH alumni who are current medical students, the most interested specialty is internal medicine. Before enrolling, a large number of alumni expressed a strong desire to practice in underserved communities in Hawaiʻi and the Pacific Basin. After completing IH, an even greater percentage expressed their dedication, with over 75% of practicing alumni serving in these areas of need. Furthermore, a majority of residents and medical students expressed a strong desire to practice in Hawaiʻi and the Pacific Basin. The top ethnic populations that practicing and retired IH alumni serve are Native Hawaiians and Pacific Islanders, Asians, and Whites. Discussion: IH alumni’s choice of specialty shows that IH generates physicians who are willing to fill the primary care gap in Hawaiʻi and the Pacific Basin [1]. The alignment between IH alumni’s origins and choice of practice locations reflects the program's success in retaining current and future healthcare professionals in areas with underserved populations. Although IH is not ethnicity based, many participants come from ethnic minority groups, populations, and communities that are medically underserved. Physicians who come from underserved and minority communities are more likely to provide care to underserved populations [2]. The populations served by IH alumni support that IH is creating alumni who are providing greater access to healthcare in historically underserved populations. This research is limited by a small sample size due to outdated contact information of alumni and collection of data through electronic surveys. The absence of investigation into other predictive factors on IH alumni’s specialty and location of practice limits the scope of the study. It can be concluded though, that IH has contributed to its goal of improving healthcare equity in Hawaiʻi and the Pacific Basin by increasing primary care physicians and healthcare access to underserved communities. The IH program’s infrastructure works in providing disadvantaged students an opportunity to attend medical school, and it can serve as a template for other medical schools interested in providing alternative pathways for disadvantaged students. Target Audience: Medical Educators, University Administrators, Diversity Officers<p/

Patient reminder and recall interventions to improve immunization rates

BackgroundImmunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care, and large demands on primary care providers, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. One common theme across immunization programs in many nations involves the challenge of implementing a population-based approach and identifying all eligible recipients, for example the children who should receive the measles vaccine. However, this issue is gradually being addressed through the availability of immunization registries and electronic health records. A second common theme is identifying the best strategies to promote high vaccination rates. Three types of strategies have been studied: (1) patient-oriented interventions, such as patient reminder or recall, (2) provider interventions, and (3) system interventions, such as school laws. One of the most prominent intervention strategies, and perhaps best studied, involves patient reminder or recall systems. This is an update of a previously published review.ObjectivesTo evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations.Search methodsWe searched CENTRAL, MEDLINE, Embase and CINAHL to January 2017. We also searched grey literature and trial registers to January 2017.Selection criteriaWe included randomized trials, controlled before and after studies, and interrupted time series evaluating immunization-focused patient reminder or recall interventions in children, adolescents, and adults who receive immunizations in any setting. We included no-intervention control groups, standard practice activities that did not include immunization patient reminder or recall, media-based activities aimed at promoting immunizations, or simple practice-based awareness campaigns. We included receipt of any immunizations as eligible outcome measures, excluding special travel immunizations. We excluded patients who were hospitalized for the duration of the study period.Data collection and analysisWe used the standard methodological procedures expected by Cochrane and the Cochrane Effective Practice and Organisation of Care (EPOC) Group. We present results for individual studies as relative rates using risk ratios, and risk differences for randomized trials, and as absolute changes in percentage points for controlled before-after studies. We present pooled results for randomized trials using the random-effects model.Main resultsThe 75 included studies involved child, adolescent, and adult participants in outpatient, community-based, primary care, and other settings in 10 countries.Patient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (risk ratio (RR) of 1.28, 95% confidence interval (CI) 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.Three types of single-method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single-method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).Based on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non-influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants).Authors' conclusionsPatient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations