Increasing HCAHPS Scores by Scripting of Hourly Rounding

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized national report on patient perceptions of care and is now linked to hospital reimbursement by both government and now some independent insurance companies. Healthcare systems are therefore very interested in ways to increase patient satisfaction within their facilities. This evidence-based practice pilot project was based on the Iowa Model of Evidence and used a quasi-experimental process to ascertain if adding scripting to the hourly rounding process was able to increase patient satisfaction scores on the HCAHPS. The increase in patient satisfaction, in the area of perceived responsiveness of the staff specifically, indicates the patient satisfaction was affected by the scripting intervention

The distributional effects of NAFTA in Mexico: evidence from a panel of municipalities

This paper studies the regional distribution of the benefits from trade in Mexico after NAFTA. Specifically, we ask whether or not NAFTA has increased the concentration of economic activity in Mexico. Unlike previous work which uses state-level data, we identify the effect of NAFTA on economic activity at the municipal level allowing us to observe detailed growth patterns across space. Further, to explicitly identify the effect of the trade agreement, we compare results for growth in traded and non-traded sectors. Given the spatial nature of these data, we make explicit use of spatial econometrics methods. We find that NAFTA caused the wealthy regions nearest to the border to grow faster than others, increasing regional disparity. Second, we find that larger municipalities experienced greater per-capita economic benefits from NAFTA. This effect is particularly noticeable in the north. Somewhat surprisingly, we find that regions with a less literate workforce and worse infrastructure grew faster than other areas after the trade agreement, decreasing regional disparity. We notice these redistributive effects occur primarily in the non-traded sectors.Regional Disparities, Trade Liberalization, Agglomeration Economies, Economic Growth, Mexico, Transport Cost, Spatial econometrics, Community/Rural/Urban Development, International Development, International Relations/Trade,

Biblioteca pública Claustro de inclusión a partir de la exclusión

Trabajo de gradoCon este proyecto se busca dar soluciones a las problemáticas sociales, ambientales y culturales. Por medio de un diseño urbano que articule todos los elementos para lograr una apropiación adecuada del habitante.INTRODUCCIÓN 1. CARACTERIZACIÓN DEL LUGAR DE INTERVENCIÓN 2. MARCO TEORICO REFERENCIAL 3. OBJETIVOS 4. PLANTEAMIENTO DEL PROBLEMA 5. CLAUSTRO DISEÑO DE INCLUSIÓN A PARTIR DE LA EXCLUSIÓN 6. ESTRATEGIAS URBANAS 7. ESTRATEGIAS ARQUITECTÓNICAS 8. ESTRATEGIAS CONSTRUCTIVAS 9. CONCLUSIONES BIBLIOGRAFÍA ANEXOSPregradoArquitect

DYNAMIC DISSOLVED ORGANIC MATTER RESPONSE TO INCREASES OF ENERGY AVAILABILITY IN FORESTED HEADWATER STREAMS

Forested headwater streams receive inputs of dissolved organic matter (DOM) that can be transformed by biota as they are transported downstream. Biotic uptake of ambient DOM is difficult to assess through direct experimentation, as the fate of a specific organic compound added to a stream is unlikely to mirror that of the ambient DOM pool. Here we examined the dynamics of DOM by using a hybrid approach that combines uptake metrics of a simple organic compound with a direct assessment of the effects of adding this presumably labile organic carbon source (acetate) on the ambient DOM pool. We proposed that adding acetate could result in three different types of responses in the ambient DOM pool: inert, production and priming. Our results provide evidence that each of these scenarios can occur in small streams, but among all our study sites the overall response of ambient dissolved organic (DOC) to added acetate was production of additional DOC, while the dissolved organic nitrogen (DON) pool was unresponsive to addition of acetate (inert response)

Investigation and Prosecution of Sexual Assault, Domestic Violence, and Stalking

This project examined sexual assault, domestic violence, and stalking cases reported to the Alaska State Troopers. More specifically, we examined all sexual assault and sexual abuse of minor incidents reported to Alaska State Troopers in 2003 and 2004, all assaults in domestic violence incidents reported to Alaska State Troopers in 2004, and all stalking incidents reported to Alaska State Troopers from 1994 to 2005. In addition, we examined whether cases were referred to the Alaska Department of Law for prosecution, were accepted for prosecution, and resulted in a conviction. This report provides a thorough overview of key characteristics on reports, suspects, victims, incidents, witnesses, and legal resolutions. This report also examines the predictors of legal resolutions. Finally, this report examines whether rural cases are less likely to have successful legal resolutions. Results clearly show that what Alaska State Troopers do when investigating reported offenses can increase rates of referral, acceptance, and conviction. In addition, we found no evidence of under-enforcement in rural areas. Contrary to allegations that the provision of criminal justice services is diminished in rural areas, we found that geographic isolation does not hinder case processing. These results are important for other rural jurisdictions. Most importantly, we found that cases first reported to local first responders had better legal resolutions. This finding suggests that the resources provided by these first responders (i.e., reduced response time and enhanced investigation) increase the rates of prosecutions and convictions. This finding is important not just in Alaska, but in other jurisdictions where official responders are not immediately available.National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Grant No. 2005-WG-BX-0011I. Index of Tables and Figures / II. Acknowledgments / III. Executive Summary / IV. Goals and Background for this Study / V. State of Alaska / VI. Sexual Assault / VII. Domestic Violence / VIII. Stalking / IX. References / X. Appendice

Assaults in Domestic Violence Incidents Reported to Alaska State Troopers

Originally published in the Alaska Justice Forum 25(3): 1, 7–12 (Fall 2008).This study examined 1,281 cases with an assault charge involving domestic violence reported to Alaska State Troopers in 2004, and excluded any cases reported to local or municipal departments. * Eighty-two percent of reports were handled by three detachment areas: 32% in C — “ Western Alaska, 29% in D — “ Interior Alaska, and 22% in B — “ Southcentral Alaska. Troopers received 80% of the reports, while 20% were received by Village Police Officers, Village Public Safety Officers, or Tribal Police Officers. Eighty-one percent of the assault charges were in the fourth degree. Eighty-four percent of assaults were reported within 24 hours, and 89% of victims and 81% of suspects were interviewed on the day of the report. * Seventy-six percent of suspects were male and 24% were female. On average, suspects were 33 years old and victims were 32 years old. The majority of assaults in domestic violence incidents (86%) were intra-racial. Fifty-seven percent of suspects and 32% of victims used alcohol. Overall, alcohol was involved in 59% of domestic violence incidents reported to Troopers. * Most assaults in domestic violence incidents (75%) occurred between victims and suspects who were staying or living together. The most common forms of violence (disclosed by victims and documented by officers) included pushing, grabbing, or shoving the victim (in 48% of incidents), punching the victim (in 29%), and slapping or hitting the victim (in 28%). Weapons such as knives or guns were rarely used. The most common injuries included bruising (for 38% of victims), lacerations or bite marks (for 27%), bloody nose or lips (for 10%), and black or swollen eyes (for 10%). Forty-three percent of incidents occurred in the presence of children. * Eighty percent of cases were referred to the Alaska Department of Law for prosecution, 68% were accepted for prosecution, and 54% resulted in a conviction. Overall conviction rates were slightly lower for female suspects, but conviction rates were generally not affected by victim gender or victim-suspect relationship

Alaska Victimization Survey: From Research to Policy and Practice

This project was supported by the Alaska Council on Domestic Violence and Sexual Assault. Points of view in this document are those of the authors and do not necessarily represent the official position or policies of the Council, the Alaska Department of Public Safety, or the State of Alaska.The Justice Center at the University of Alaska Anchorage partnered with the Council on Domestic Violence and Sexual Assault to conduct a statewide victimization survey. The Alaska Victimization Survey was modeled after the National Intimate Partner and Sexual Violence Surveillance System (NISVSS) survey, developed by the Centers for Disease Control and Prevention in collaboration with the National Institute of Justice and the Department of Defense. The NISVSS survey is designed to “generate accurate and reliable lifetime and 12-month incidence and prevalence estimates on intimate partner violence (physical aggression, psychological aggression, and sexual violence); sexual violence (unwanted sexual situations, abusive sexual contact, and completed or attempted sex without consent); and stalking” (CDC). This poster presents key results from the Alaska Victimization Survey and identifies how survey results are being used to impact policy and practice.Council on Domestic Violence and Sexual Assault, Alaska Department of Public SafetyAbstract / UCR Forcible Rape Statistice: 1996–2009 / Survey Methods / Measures / Results / Dissemination / Impact on Policy & Practic

A functional genomics pipeline to identify high-value asthma and allergy CpGs in the human methylome

BACKGROUND: DNA methylation of cytosines at cytosine-phosphate-guanine (CpG) dinucleotides (CpGs) is a widespread epigenetic mark, but genome-wide variation has been relatively unexplored due to the limited representation of variable CpGs on commercial high-throughput arrays. OBJECTIVES: To explore this hidden portion of the epigenome, this study combined whole-genome bisulfite sequencing with in silico evidence of gene regulatory regions to design a custom array of high-value CpGs. This study focused on airway epithelial cells from children with and without allergic asthma because these cells mediate the effects of inhaled microbes, pollution, and allergens on asthma and allergic disease risk. METHODS: This study identified differentially methylated regions from whole-genome bisulfite sequencing in nasal epithelial cell DNA from a total of 39 children with and without allergic asthma of both European and African ancestries. This study selected CpGs from differentially methylated regions, previous allergy or asthma epigenome-wide association studies (EWAS), or genome-wide association study loci, and overlapped them with functional annotations for inclusion on a custom Asthma&Allergy array. This study used both the custom and EPIC arrays to perform EWAS of allergic sensitization (AS) in nasal epithelial cell DNA from children in the URECA (Urban Environment and Childhood Asthma) birth cohort and using the custom array in the INSPIRE [Infant Susceptibility to Pulmonary Infections and Asthma Following RSV Exposure] birth cohort. Each CpG on the arrays was assigned to its nearest gene and its promotor capture Hi-C interacting gene and performed expression quantitative trait methylation (eQTM) studies for both sets of genes. RESULTS: Custom array CpGs were enriched for intermediate methylation levels compared to EPIC CpGs. Intermediate methylation CpGs were further enriched among those associated with AS and for eQTMs on both arrays. CONCLUSIONS: This study revealed signature features of high-value CpGs and evidence for epigenetic regulation of genes at AS EWAS loci that are robust to race/ethnicity, ascertainment, age, and geography

Gene-based association study of rare variants in children of diverse ancestries implicates TNFRSF21 in the development of allergic asthma

BACKGROUND: Most genetic studies of asthma and allergy have focused on common variation in individuals primarily of European ancestry. Studying the role of rare variation in quantitative phenotypes and in asthma phenotypes in populations of diverse ancestries can provide additional, important insights into the development of these traits. OBJECTIVE: We sought to examine the contribution of rare variants to different asthma- or allergy-associated quantitative traits in children with diverse ancestries and explore their role in asthma phenotypes. METHODS: We examined whole-genome sequencing data from children participants in longitudinal studies of asthma (n = 1035; parent-identified as 67% Black and 25% Hispanic) to identify rare variants (minor allele frequency \u3c 0.01). We assigned variants to genes and tested for associations using an omnibus variant-set test between each of 24,902 genes and 8 asthma-associated quantitative traits. On combining our results with external data on predicted gene expression in humans and mouse knockout studies, we identified 3 candidate genes. A burden of rare variants in each gene and in a combined 3-gene score was tested for its associations with clinical phenotypes of asthma. Finally, published single-cell gene expression data in lower airway mucosal cells after allergen challenge were used to assess transcriptional responses to allergen. RESULTS: Rare variants in USF1 were significantly associated with blood neutrophil count (P = 2.18 × 10 CONCLUSIONS: We report novel associations between rare variants in genes and allergic and inflammatory phenotypes in children with diverse ancestries, highlighting TNFRSF21 as contributing to the development of allergic asthma