Practice level factors associated with enhanced engagement with practice facilitators; findings from the heart health now study

Background: Practice facilitation is a promising strategy to enhance care processes and outcomes in primary care settings. It requires that practices and their facilitators engage as teams to drive improvement. In this analysis, we explored the practice and facilitator factors associated with greater team engagement at the mid-point of a 12-month practice facilitation intervention focused on implementing cardiovascular prevention activities in practice. Understanding factors associated with greater engagement with facilitators in practice-based quality improvement can assist practice facilitation programs with planning and resource allocation. Methods: One hundred thirty-six ambulatory care small to medium sized primary care practices that participated in the EvidenceNow initiative's NC Cooperative, named Heart Health Now (HHN), fit the eligibility criteria for this analysis. We explored the practice and facilitator factors associated with greater team engagement at the mid-point of a 12-month intervention using a retrospective cohort design that included baseline survey data, monthly practice activity implementation data and information about facilitator's experience. Generalized linear mixed-effects models (GLMMs) identified variables associated with greater odds of team engagement using an ordinal scale for level of team engagement. Results: Among our practice cohort, over half were clinician-owned and 27% were Federally Qualified Health Centers. The mean number of clinicians was 4.9 (SD 4.2) and approximately 40% of practices were in Medically Underserved Areas (MUA). GLMMs identified a best fit model. The Model presented as odd ratios and 95% confidence intervals suggests greater odds ratios of higher team engagement with greater practice QI leadership 17.31 (5.24-57.19), [0.00], and practice location in a MUA 7.25 (1.8-29.20), [0.005]. No facilitator characteristics were independently associated with greater engagement. Conclusions: Our analysis provides information for practice facilitation stakeholders to consider when considering which practices may be more amendable to embracing facilitation services

Extent and Causes of Chesapeake Bay Warming

Coastal environments such as the Chesapeake Bay have long been impacted by eutrophication stressors resulting from human activities, and these impacts are now being compounded by global warming trends. However, there are few studies documenting long-term estuarine temperature change and the relative contributions of rivers, the atmosphere, and the ocean. In this study, Chesapeake Bay warming, since 1985, is quantified using a combination of cruise observations and model outputs, and the relative contributions to that warming are estimated via numerical sensitivity experiments with a watershed–estuarine modeling system. Throughout the Bay’s main stem, similar warming rates are found at the surface and bottom between the late 1980s and late 2010s (0.02 +/- 0.02C/year, mean +/- 1 standard error), with elevated summer rates (0.04 +/- 0.01C/year) and lower rates of winter warming (0.01 +/- 0.01C/year). Most (~85%) of this estuarine warming is driven by atmospheric effects. The secondary influence of ocean warming increases with proximity to the Bay mouth, where it accounts for more than half of summer warming in bottom waters. Sea level rise has slightly reduced summer warming, and the influence of riverine warming has been limited to the heads of tidal tributaries. Future rates of warming in Chesapeake Bay will depend not only on global atmospheric trends, but also on regional circulation patterns in mid-Atlantic waters, which are currently warming faster than the atmosphere. Supporting model data available at: https://doi.org/10.25773/c774-a36

Deep incision in an Aptian carbonate succession indicates major sea-level fall in the Cretaceous

Long-term relative sea-level cycles (0 5 to 6 Myr) have yet to be fully understood for the Cretaceous. During the Aptian, in the northern Maestrat Basin (Eastern Iberian Peninsula), fault-controlled subsidence created depositional space, but eustasy governed changes in depositional trends. Relative sea-level history was reconstructed by sequence stratigraphic analysis. Two forced regressive stages of relative sea-level were recognized within three depositional sequences. The first stage is late Early Aptian age (intra Dufrenoyia furcata Zone) and is characterized by foreshore to upper shoreface sedimentary wedges, which occur detached from a highstand carbonate platform, and were deposited above basin marls. The amplitude of relative sea-level drop was in the order of tens of metres, with a duration of 2 km wide and cut 115 m down into the underlying Aptian succession. With the subsequent transgression, the incision was back-filled with peritidal to shallow subtidal deposits. The changes in depositional trends, lithofacies evolution and geometric relation of the stratigraphic units characterized are similar to those observed in coeval rocks within the Maestrat Basin, as well as in other correlative basins elsewhere. The pace and magnitude of the two relative sea-level drops identified fall within the glacio-eustatic domain. In the Maestrat Basin, terrestrial palynological studies provide evidence that the late Early and Late Aptian climate was cooler than the earliest part of the Early Aptian and the Albian Stage, which were characterized by warmer environmental conditions. The outcrops documented here are significant because they preserve the results of Aptian long-term sea-level trends that are often only recognizable on larger scales (i.e. seismic) such as for the Arabian Plate

The brand description of Sainsbury's and Aldi:price quality positioning

Purpose – The research outlined in this paper seeks to establish whether or not there are discernible differences in the positioning attributes of Aldi and Sainsbury's. Particular emphasis is given to price positioning and to what extent this can be explained by product quality differences. Design/methodology/approach – Price differences are assessed using the shopping basket technique and product quality differences are evaluated using perceptual discrimination tests conducted blind of brand. Where differences between products are discernible, product preference is identified. Findings – The study identified discernible differences in the pricing strategies of Sainsbury's and Aldi particularly amongst the higher added value products. Although differences in product quality were evident in some product categories, there was no statistically significant preference for one brand over the other. Research limitations/implications – Owing to the resource intensive nature of perceptual discrimination tests, this research was conducted on a relatively small number of products and cannot be extrapolated to the full range of products available from either retailer, though it may indicate comparable quality. Originality/value – This paper evaluates the brand description of two UK-based retailers, Sainsbury's and Aldi. In market positioning, they are at different ends of the retailing spectrum, with Sainsbury's a high added value retailer with an ABC1 consumer profile, and Aldi a hard discounter with a largely C2D consumer base. However, this study is based on a retail site that has the two brands located directly opposite each other in a conspicuously AB suburb of a major UK city. This location deviates from the holistic profile of the Aldi brand and as such provides a special research site

Research Progress Report, No. 4

The fertilizer application method used for producing small grains in interior Alaska is not always a matter of choice but of necessity. Farmers must fertilize, till, and seed a large acreage in a short time to complete the seeding operation no later than the last week in May. In most years, this allows time for the crop to mature before being damaged by autumn frosts. A typical fertilizer application for barley is 380 pounds per acre dry, blended material consisting of 100 pounds urea as the primary nitrogen (N) source, 100 pounds monoammonium phosphate, 100 pounds ammonium sulfate, and 80 pounds potassium chloride. This combination provides an application ratio of 77-51-48-24 pounds per acre N, P20 5, K20 , and sulfur (S). This means a farmer planting 1000 acres of barley must handle 190 tons of fertilizer material. The most expedient method is to use a 10- to 20-ton capacity, trailer-type, broadcast spreader which minimizes refilling time. If fields are tilled after fertilization, the material is mixed into the soil; otherwise the fertilizer remains on the soil surface. There are several reasons to investigate other methods of fertilizer application even though this system has worked reasonably well. Most barley produced in interior Alaska is seeded on lands which have been cleared of native vegetation in the last ten years (Lewis and Thomas 1982). Soils are naturally infertile and are cool throughout the growing season (Siddoway et al. 1984), and most have been cropped for only three or four years. Delucchi (1983) reported higher yield response when phosphorus (P) was banded with the seed than when equal applications were broadcast. This is not atypical for P-deficient soils (Cooke 1982). Some farmers in Alaska’s interior have begun to band a starter or “ pop-up” fertilizer in the row with the seed at the time of planting. Monoammonium phosphate (11 pounds N and 51 pounds P20 5 per acre) is typically used. Starter fertilizers banded with the seed render nutrients readily available to the seedlings and may boost plant growth early in the season helping seedlings overcome stress due to cold soil temperatures at planting and during early growth (Veseth 1986, Paul 1987). Yields could potentially be increased and/or fertilizer requirements reduced. A general rule has been to band no more than 140 pounds per acre total fertilizer containing no more than 15 to 20 pounds N per acre with the seed (Loynachan et al. 1979). Particular caution is urged when urea is used as an N source (Cooke 1982, Robertson 1982). There is a possibility of seedling injury from excessive salts or the release of toxic quantities of ammonia near the seed. Several farmers in the interior of Alaska have banded the total nutrient requirement for barley with the seed using urea as the major N source. Good yield results have been reported for several years with no evidence of crop injury at rates of up to 450 pounds of total material per acre. Delucchi (1983) speculated that in wetter soils, typical of newly cleared lands, salts may tend to dissolve and diffuse away from the seed thereby lessening the potential for seedling damage. Banding the full nutrient requirement for barley with the seed may increase yields over those found when the equal amount is broadcast, thus increasing returns. Elimination of the broadcast operation will reduce costs slightly. Urea is available locally at a lesser cost than other N sources which must be shipped into the state and may be more cost effective than other formulations