Modeling canopy-induced turbulence in the Earth system: a unified parameterization of turbulent exchange within plant canopies and the roughness sublayer (CLM-ml v0)

Land surface models used in climate models neglect the roughness sublayer and parameterize within-canopy turbulence in an ad hoc manner. We implemented a roughness sublayer turbulence parameterization in a multilayer canopy model (CLM-ml v0) to test if this theory provides a tractable parameterization extending from the ground through the canopy and the roughness sublayer. We compared the canopy model with the Community Land Model (CLM4.5) at seven forest, two grassland, and three cropland AmeriFlux sites over a range of canopy heights, leaf area indexes, and climates. CLM4.5 has pronounced biases during summer months at forest sites in midday latent heat flux, sensible heat flux, gross primary production, nighttime friction velocity, and the radiative temperature diurnal range. The new canopy model reduces these biases by introducing new physics. Advances in modeling stomatal conductance and canopy physiology beyond what is in CLM4.5 substantially improve model performance at the forest sites. The signature of the roughness sublayer is most evident in nighttime friction velocity and the diurnal cycle of radiative temperature, but is also seen in sensible heat flux. Within-canopy temperature profiles are markedly different compared with profiles obtained using Monin–Obukhov similarity theory, and the roughness sublayer produces cooler daytime and warmer nighttime temperatures. The herbaceous sites also show model improvements, but the improvements are related less systematically to the roughness sublayer parameterization in these canopies. The multilayer canopy with the roughness sublayer turbulence improves simulations compared with CLM4.5 while also advancing the theoretical basis for surface flux parameterizations

U.S. Women's Intended Sources for Reproductive Health Care

Introduction: The current sociopolitical climate and context of the Affordable Care Act have led some to question the future role of family planning clinics in reproductive health care. We explored where women plan to get their future contraception, pelvic exam/pap smears, and sexually transmitted infection testing, with a focus on the role of family planning clinics. Methods: Data were drawn from a study of United States adults conducted in January 2013 from a national online panel. We focused on English-literate women aged 18?45 years who answered items on intended sources of care (private office/health maintenance organization [HMO], family planning clinic, other, would not get care) for reproductive health services. We used Rao-Scott F tests to compare intended sources across sociodemographic groups, and logistic regression to model odds of intending to use family planning clinics. Probability weights were used to adjust for the complex sampling design. Results: The response rate was 61% (n?=?2,182). Of the 723 respondents who met the inclusion criteria, approximately half intended to use private offices/HMOs. Among some subgroups, including less educated (less than high school), lower annual incomes (<$25,000) and uninsured women, the proportion intending to use family planning clinics was higher than the proportion intending to use private office/HMO in unadjusted analyses. Across all service types, unmarried and uninsured status were associated with intention to use family planning clinics in multivariable models. Conclusions: While many women intend to use private offices/HMOs for their reproductive health care, family planning clinics continue to play an important role, particularly for socially disadvantaged women.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140133/1/jwh.2014.5116.pd

Not Managing Expectations: A Grounded Theory of Intimate Partner Violence From the Perspective of Pakistani People

Intimate partner violence (IPV) is a major social and public health problem affecting people from different cultures and societies. Much research has been undertaken to understand the phenomenon, its determinants, and its consequences in numerous countries. However, there is a paucity of research on IPV in many areas of the world including Pakistan. The present study aimed to develop a theory of the meaning and process of IPV from the perspective of Pakistani men and women living in and outside Pakistan

A Systems Approach to Improving Rural Care in Ethiopia

Background: Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. Methodology/Principal Findings: We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs) in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI), we identified PHCUs with consistently higher performance (n = 2), most improved performance (n = 3), or consistently lower performance (n = 2) in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51), we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1) managerial problem solving capacity, 2) relationship with the woreda (district) health office, and 3) community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, an

The use of therapy dogs to support court users in the waiting room

The use of animals to support individuals' wellbeing has been documented across a variety of disciplines. It has been over a decade since dogs have also started to be used within the criminal justice setting in America to support vulnerable people, but this practice is not common in the United Kingdom. Globally, empirical evidence to support the benefits of utilising dogs within the criminal justice system is lacking. The present interdisciplinary study aimed to explore one aspect of the criminal justice journey, the impact a therapy dog can have on UK court users waiting to give evidence at a magistrate's court. 117 court users and 8 court staff were interviewed to explore their perceptions of a therapy dog service offered at a local magistrates’ court. Using thematic analysis, three main themes were discovered: (1) Context of the court environment, (2) Effect of the therapy dog on well-being, and (3) Issues relating to therapy dogs in court waiting areas. Results suggests that therapy dogs have a number of benefits to court users. Long-term, the human-canine interaction positively translates into the court waiting room environment and so it should be further explored, evaluated and then appropriately implemented in the UK’s legal system

End of life care: The experiences of advance care planning amongst family caregivers of people with advanced dementia - A qualitative study

Background: End of life decisions for people with advanced dementia are reported as often being difficult for families as they attempt to make appropriate and justified decisions. Aim: To explore the experiences of advance care planning amongst family caregivers of people with advanced dementia. Design: Qualitative research including a series of single cases (close family relatives). Methods: A purposive sample of 12 family caregivers within a specialist dementia unit was interviewed about their experiences of advance care planning between August 2009 and February 2010. Results/Findings: Family caregivers need encouragement to ask the right questions during advance care planning to discuss the appropriateness of nursing and medical interventions at the end of life. Conclusions: Advance care planning can be facilitated with the family caregiver in the context of everyday practice within the nursing home environment for older people with dementia

Opportunities for primary and secondary prevention of excess gestational weight gain: General Practitioners' perspectives

BackgroundThe impact of excess gestational weight gain (GWG) on maternal and child health outcomes is well documented. Understanding how health care providers view and manage GWG may assist with influencing healthy gestational weight outcomes. This study aimed to assess General Practitioner\u27s (GPs) perspectives regarding the management and assessment of GWG and to understand how GPs can be best supported to provide healthy GWG advice to pregnant women.MethodsDescriptive qualitative research methods utilising semi - structured interview questions to assess GPs perspectives and management of GWG. GPs participating in shared antenatal care in Geelong, Victoria and Sydney, New South Wales were invited to participate in semi - structured, individual interviews via telephone or in person. Interviews were digitally recorded and transcribed verbatim. Data was analysed utilising thematic analysis for common emerging themes.ResultsTwenty eight GPs participated, 14 from each state. Common themes emerged relating to awareness of the implications of excess GWG, advice regarding weight gain, regularity of gestational weighing by GPs, options for GPs to seek support to provide healthy lifestyle behaviour advice and barriers to engaging pregnant women about their weight. GPs perspectives concerning excess GWG were varied. They frequently acknowledged maternal and child health complications resulting from excess GWG yet weighing practices and GWG advice appeared to be inconsistent. The preferred support option to promote healthy weight was referral to allied health practitioners yet GPs noted that cost and limited access were barriers to achieving this.ConclusionsGPs were aware of the importance of healthy GWG yet routine weighing was not standard practice for diverse reasons. Management of GWG and perspectives of the issue varied widely. Time efficient and cost effective interventions may assist GPs in ensuring women are supported in achieving healthy GWG to provide optimal maternal and infant health outcomes.<br /

Quality improvement in small office settings: an examination of successful practices

<p>Abstract</p> <p>Background</p> <p>Physicians in small to moderate primary care practices in the United States (U.S.) (<25 physicians) face unique challenges in implementing quality improvement (QI) initiatives, including limited resources, small staffs, and inadequate information technology systems 23,36. This qualitative study sought to identify and understand the characteristics and organizational cultures of physicians working in smaller practices who are actively engaged in measurement and quality improvement initiatives.</p> <p>Methods</p> <p>We undertook a qualitative study, based on semi-structured, open-ended interviews conducted with practices (N = 39) that used performance data to drive quality improvement activities.</p> <p>Results</p> <p>Physicians indicated that benefits to performing measurement and QI included greater practice efficiency, patient and staff retention, and higher staff and clinician satisfaction with practice. Internal facilitators included the designation of a practice champion, cooperation of other physicians and staff, and the involvement of practice leaders. Time constraints, cost of activities, problems with information management and or technology, lack of motivated staff, and a lack of financial incentives were commonly reported as barriers.</p> <p>Conclusion</p> <p>These findings shed light on how physicians engage in quality improvement activities, and may help raise awareness of and aid in the implementation of future initiatives in small practices more generally.</p

Lack of effective communication between communities and hospitals in Uganda: a qualitative exploration of missing links

<p>Abstract</p> <p>Background</p> <p>Community members are stakeholders in hospitals and have a right to participate in the improvement of quality of services rendered to them. Their views are important because they reflect the perspectives of the general public. This study explored how communities that live around hospitals pass on their views to and receive feedback from the hospitals' management and administration.</p> <p>Methods</p> <p>The study was conducted in eight hospitals and the communities around them. Four of the hospitals were from three districts from eastern Uganda and another four from two districts from western Uganda. Eight key informant interviews (KIIs) were conducted with medical superintendents of the hospitals. A member from each of three hospital management boards was also interviewed. Eight focus group discussions (FGDs) were conducted with health workers from the hospitals. Another eight FGDs (four with men and four with women) were conducted with communities within a five km radius around the hospitals. Four of the FGDs (two with men and two with women) were done in western Uganda and the other four in eastern Uganda. The focus of the KIIs and FGDs was exploring how hospitals communicated with the communities around them. Analysis was by manifest content analysis.</p> <p>Results</p> <p>Whereas health unit management committees were supposed to have community representatives, the representatives never received views from the community nor gave them any feed back from the hospitals. Messages through the mass media like radio were seen to be non specific for action. Views sent through suggestion boxes were seen as individual needs rather than community concerns. Some community members perceived they would be harassed if they complained and had reached a state of resignation preferring instead to endure the problems quietly.</p> <p>Conclusion</p> <p>There is still lack of effective communication between the communities and the hospitals that serve them in Uganda. This deprives the communities of the right to participate in the improvement of the services they receive, to assume their position as stakeholders. Various avenues could be instituted including using associations in communities, rapid appraisal methods and community meetings.</p