Late Paleoindian through Middle Archaic Faunal Evidence from Dust Cave, Alabama

This research involves the faunal evidence from the site of Dust Cave in northwest Alabama. The site was occupied by prehistoric hunter-gatherers from 10,500 to 5,200 years ago. Dust Cave is significant to archaeological research because it represents one of the earliest known, stratified Late Paleoindian and Archaic deposits in the Southeast. Test excavations were conducted at the cave from 1989-1994 and the materials for this dissertation were collected during this period. Results of the faunal analysis indicate that changes occurred in resource selection, habitat exploitation, and natural environment through time. A shift from a concentration on avian species to mammalian species occurred from the Late Paleoindian to the Middle Archaic periods. In addition, aquatic resources, which were important to Late Paleoindian people at the cave, were much less important by the Middle Archaic. Utilization of species from open, ecotone, and closed habitats also changed through time. Closed habitat species, such as squirrels and raccoons, were much more important during the early occupations of the cave. Ecotone species, such as rabbits and whitetail deer became more important during later occupations. A comparison of the Dust Cave fauna to several other archaeological sites reveals that Dust Cave is the only site in which birds are a significant resource. The faunal assemblages from almost all of the other sites were predominantly composed of mammal remains. In addition, at Dust Cave the utilization of aquatic resources decreases through time while at other sites the use of aquatics increases. The Dust Cave faunal assemblage exhibits trends observed in other southeastern faunal assemblages such as an increase in the use of whitetail deer and an increase in species from ecotone habitats through time. In sum, information on faunal remains from Dust Cave has signified that Late Paleoindian and Archaic period hunter-gatherers living at the site practiced subsistence adaptations that were particular to regional habitat conditions

Food desert versus food oasis: An exploration of residents' perceptions of factors influencing food buying practices

Utilizing concept mapping, the primary goal of this dissertation research was to explore the range of factors that influence food buying practices. A total of twenty five participants from two low-income zip codes in Pittsburgh, PA completed the concept mapping process. The participants were recruited based on residential proximity to a supermarket. This dissertation is organized around the presentation of three manuscripts. The first manuscript presents an exhaustive review of the literature related to food deserts. The research presented in manuscript two identified perceptions of factors influencing food buying practices among residents of an urban food desert (n=12) compared to a food oasis (n=13). Results identified 121 unique statements that were grouped by participants into 12 clusters, or unique concepts. Analyses show that overall, the average cluster ratings for residents of the food desert were higher than residents of the food oasis. Research presented in manuscript three addressed how residents' perceptions of factors influencing food buying practices differ by food security status. Findings show that food insecure participants rated clusters higher than food secure participants. A secondary aim was to explore how important these factors are to hindering healthy eating based on food desert and food security statuses. Overall, cluster rankings were similar for food secure participants in a food desert and food secure participants in a food oasis. However, participants in the food desert rated all of the clusters higher than participants in the food oasis. In comparing food insecure participants in a food desert to a food oasis, findings show that although cluster rankings were different, average cluster ratings were similar. The public health significance of this study is that it contributes to our understanding of factors that influence food buying practices based on neighborhood and individual-level characteristics, an area that has received limited consideration. Based on findings from this research, areas for future research, and policy and program development have been uncovered to address the lack of access to healthy foods for urban residents of low-income areas

Clean Water for Less Integrated Planning Reduces the Cost of Meeting Water Quality Goals in New Hampshire

Rising populations and increased development in New Hampshire coastal communities have led to a decline in water quality in the Great Bay Estuary. Responding effectively and affordably to new federal permit requirements for treating and discharging stormwater and wastewater will require innovative solutions from communities in the area. The Water Integration for Squamscott-Exeter (WISE) project developed an integrated planning framework through which the coastal communities of Exeter, Stratham, and Newfields could significantly reduce the cost of meeting permit requirements. In this brief, authors Alison Watts, Robert Roseen, Paul Stacey, Renee Bourdeau, and Theresa Walker report that integrated planning could save these communities over $100 million (in fifty-year lifecycle costs) by prioritizing high-impact, low-cost mitigation strategies across permit type and town boundaries. The project, which has received an Environmental Merit award from Environment Protection Agency, also found that attainment of water quality standards in the Exeter–Squamscott River will not be possible without substantial cooperation and investment from upstream communities, which are not currently subject to EPA permit requirements. Collaboration among communities in planning and implementing projects to meet clean water regulations can have significant cost and effectiveness benefits

Contributing factors that influence medication errors in the prehospital paramedic environment: a mixed-method systematic review protocol

Introduction There is limited reliable research available on medication errors in relation to paramedic practice, with most evidence-based medication safety guidelines based on research in nursing, operating theatre and pharmacy settings. While similarities exist, evidence suggests that the prehospital environment is distinctly different in many aspects. The prevention of errors requires attention to factors from the organisational and regulatory level down to specific tasks and patient characteristics. The evidence available suggests errors may occur in up to 12.76% of medication administrations in some prehospital settings. With multiple sources stating that the errors are under-reported, this represents significant potential for patient harm. This review will seek to identify the factors influencing the occurrence of medication errors by paramedics in the prehospital environment. Methods and analysis The review will include qualitative and quantitative studies involving interventions or phenomena regarding medication errors or medication safety relating to paramedics (including emergency medical technicians and other prehospital care providers) within the prehospital environment. A search will be conducted using MEDLINE (Ovid), EBSCOhost Megafile Search, the International Committee of Medical Journal Editors trial registry, Google Scholar and the OpenGrey database to identify studies meeting this inclusion criteria, with initial searches commencing 30 September 2019. Studies selected will undergo assessment of methodological quality, with data to be extracted from all studies irrespective of quality. Each stage of study selection, appraisal and data extraction will be conducted by two reviewers, with a third reviewer deciding any unresolved conflicts. The review will follow a convergent integrated approach, conducting a single qualitative synthesis of qualitative and 'qualitised' quantitative data. Ethics and dissemination No ethical approval was required for this review. Findings from this systematic review will be disseminated via publications, reports and conference presentations

Water Integration for Squamscott Exeter (WISE): Preliminary Integrated Plan, Final Technical Report

This document introduces the goals, background and primary elements of an Integrated Plan for the Lower Exeter and Squamscott River in the Great Bay estuary in southern New Hampshire. This Plan will support management of point (wastewater treatment plant) and nonpoint sources in the communities of Exeter, Stratham and Newfields. The Plan also identifies and quantifies the advantages of the use of green infrastructure as a critical tool for nitrogen management and describes how collaboration between those communities could form the basis for an integrated plan. The Plan will help communities meet new wastewater and proposed stormwater permit requirements. Critical next steps are need before this Plan will fulfill the 2018 Nitrogen Control Plan requirements for Exeter and proposed draft MS4 requirements for both Stratham and Exeter. These next steps include conducting a financial capability assessment, development of an implementation schedule and development of a detailed implementation plan. The collaborative process used to develop this Plan was designed to provide decision makers at the local, state and federal levels with the knowledge they need to trust the Plan’s findings and recommendations, and to enable discussions between stakeholders to continue the collaborative process. This Plan includes the following information to guide local response to new federal permit requirements for treating and discharging stormwater and wastewater: Sources of annual pollutant load quantified by type and community; Assessment and evaluation of different treatment control strategies for each type of pollutant load; Assessment and evaluation of nutrient control strategies designed to reduce specific types of pollutants; Evaluation of a range of point source controls at the wastewater treatment facility based on regulatory requirements; Costs associated with a range of potential control strategies to achieve reduction of nitrogen and other pollutants of concern; and A preliminary implementation schedule with milestones for target load reductions using specific practices for specific land uses at points in time; Recommendations on how to implement a tracking and accounting program to document implementation; Design tools such as BMP performance curves for crediting the use of structural practices to support nitrogen accounting requirements; and Next Steps for how to complete this Plan

Examining Administrator Perceptions on the Success of a Ninth Grade Transition Model

Ninth grade students are at a greater risk of dropping out of high school than are other grade-level populations. Factors such as a lack of academic preparedness, social and developmental changes, and the decline of parental support often result in 9th grade students falling behind in their academic work. Using holistic education as the conceptual framework, the goal of this intrinsic case study was to explore the perceptions of school and district office administrators on the impact that a 9th grade transition program has on the 9th grade retention and dropout rate of a high school located in the southeastern United States. The features of the 9th grade transition program (designated personnel, classes, location, and resources) were analyzed. Data collection occurred by a review of the school\u27s evaluation reports and one-on-one interviews using a purposeful sample with 4 school and district office administrators. Thematic analysis of data followed an open coding process to identify categories and themes. The findings indicated that the 9th grade transition program positively impacted student and school performance and revealed inconsistencies in the transition programs and services among the 3 high schools within the school district. The resulting project was a policy recommendation that advocates for the use of standard 9th grade best practices. This study contributes to positive social change through the implementation of a best practice policy recommendation, intended to reduce 9the grade retention and dropout rates of the students within the school district

Clean Water for Less

Rising populations and increased development in New Hampshire coastal communities have led to a decline in water quality in the Great Bay Estuary. Responding effectively and affordably to new federal permit requirements for treating and discharging stormwater and wastewater will require innovative solutions from communities in the area. In March 2015, the Water Integration for Squamscott–Exeter (WISE) project completed an integrated planning framework through which the coastal communities of Exeter, Stratham, and Newfields could more affordably manage permits for wastewater and stormwater. However, meeting maximum goals for nitrogen reduction will require collaboration and commitment from all municipalities in the watershed, whether regulated under the Clean Water Act or not

VCU-UNITE: Identifying Recognition Mechanisms for University-Community Engagement

The aims of the project were to determine what process would be appropriate to recognize significant contributions of university and community partners to joint community engagement projects. Our view was that several different award ceremonies exist in VCU, none of which are well attended and suggesting that this form of recognition may not be a high priority for participants. Thus, we sought to determine the awareness and extent of involvement of VCU faculty, staff and students in community engagement projects, and to find out what format of recognition process would be appealing to both university and community participants. We gathered this information through surveys and focus groups, analyzed the data and determined that university and community partners had differing views on what types of recognition would be desirous. Next, we designed a web portal through which nominations could be made by members of the university and by the community. We propose a streamlined nomination and online review process, leading to a quarterly award consisting of a letter of thanks from the Division of Community Engagement, and a photograph and narrative placed on the VCU website. Recipients of quarterly awards would automatically compete for an annual award, such as P&T credit or additional community leave time (university), or a scholarship, a plaque, or recognition at a VCU event (community)

Clinical effectiveness of the START (STrAtegies for RelaTives) psychological intervention for family carers and the effects on the cost of care for people with dementia: 6-year follow-up of a randomised controlled trial

Background: The START (STrAtegies for RelaTives) intervention reduced depressive and anxiety symptoms of family carers of relatives with dementia at home over 2 years and was cost-effective. Aims:To assess the clinical effectiveness over 6 years and the impact on costs and care home admission. Method: We conducted a randomised, parallel group, superiority trial recruiting from 4 November 2009 to 8 June 2011 with 6-year follow-up (trial registration: ISCTRN 70017938). A total of 260 self-identified family carers of people with dementia were randomised 2:1 to START, an eight-session manual-based coping intervention delivered by supervised psychology graduates, or to treatment as usual (TAU). The primary outcome was affective symptoms (Hospital Anxiety and Depression Scale, total score (HADS-T)). Secondary outcomes included patient and carer service costs and care home admission. Results: In total, 222 (85.4%) of 173 carers randomised to START and 87 to TAU were included in the 6-year clinical efficacy analysis. Over 72 months, compared with TAU, the intervention group had improved scores on HADS-T (adjusted mean difference −2.00 points, 95% CI −3.38 to −0.63). Patient-related costs (START versus TAU, respectively: median £5759 v. £16 964 in the final year; P = 0.07) and carer-related costs (median £377 v. £274 in the final year) were not significantly different between groups nor were group differences in time until care home (intensity ratio START:TAU was 0.88, 95% CI 0.58–1.35). Conclusions: START is clinically effective and this effect lasts for 6 years without increasing costs. This is the first intervention with such a long-term clinical and possible economic benefit and has potential to make a difference to individual carers