Using Short Message Services (SMS) to Reduce No-Show Rates an Evidence-Based Practice Project

Abstract Background: No-shows (NS) are correlated with reduced treatment efficacy, increased financial burden on medical institutions, and early treatment termination for therapy. NS occur for a variety of reasons and appointment compliance within outpatient mental health clinics has a wide variance with clinics reporting no-shows ranging from 15% to 50%. This section of the project is a continuation started by an earlier USD DNP student Fernando Serrano, in which the projects aims were expanded beyond the participation of nurse practitioners only to now include marriage family therapists (MFT), psychologists and medical residents, and to address the NS rates clinic-wide. One year after the initial project was implemented, the year-to-date no-show rates for the entire clinic was 11.40%. For residents it was 12.58%, for nurse practitioners (NP) it was 5.71%, and for MFTs and psychologists it was 12.82%. Purpose of the Project: Providers and staff will offer patients the ability to sign up for Short Message Services (SMS) appointment reminders. Patients who agree to SMS will receive text messages to their phone with an appointment reminder on the day prior. The goal is to increase SMS use with patients and reduce missed appointments (MA) by 20% clinic-wide and within each group of clinicians. Framework/EBP Model: The IOWA model was used for this project. Evidence-Based Intervention: With continual reduced cost and substantial increase in mobile phone technology usage by the general population, SMS has become a new mainstay for direct communication. SMS appointment reminders have been successfully implemented in mental health, radiology, physical therapy, and dentistry with each setting experiencing a significant decrease in no-show rates. Implementation: After clinic and university IRB approval, SMS teaching material, printouts and reminder notes for providers were prepared. Qualitative statements from the three disciplines about attitude and barriers regarding SMS collected before, during and after the project’s implementation. Pre-data collection included surveying MA rates among all clinic patients for the previous 8 weeks. 15-30-minute teaching sessions took place with psychiatric mental health nurse practitioners (PMHNP), PMHNP students, MFT’s, psychologists, residents, and administration staff. SMS “How to” flyers posted in provider communal areas and in each provider room to instruct and remind providers and staff to offer SMS reminders to patients. Data was collected weekly for 8 weeks examining MAs and provider/staff SMS compliance with offering SMS to patients. Data was continually collected on secured hard drives on excel spreadsheets. Data was generated from reports without any patient identification information. Evaluation Results: We expected at least 50% of the providers/students/staff would report they are offering SMS to patients at the end of the first 4 week and at least 75% by the end of 8 weeks. We predicted at least 70% SMS signup with patients and a reduction in no-show rates by 20% upon project completion. Implications for Clinical Practice: We anticipated all providers and staff at the clinic would offer SMS sign up as a part of standard policy and procedure. As SMS sign ups grows, NS will decrease. With a further decrease in clinic wide no-show rates, this program could possibly be rolled out to other UCSD clinic sites. Conclusions: The brevity, efficiency and cost-effectiveness of SMS allows patients to quickly be reminded of upcoming appointments with the choice to confirm or reschedule as needed. SMS helps increase appointment attendance while reducing provider nonproductive hours from no-shows

Sustainability as a contribution to long-term success

Is sustainability a contribution to long-term success? How does it work? Using the case of German graphic design industry businesses, this article explores the influence of sustainability as a contribution to long-term success

An examination of owner managers’ perceptions of sustainability as a contribution to long-term success in the German graphic design industry : A critical analysis of the influence of the use of sustainability.

This thesis explores the research gap on the influence of sustainability as a contribution to long-term success in businesses of German graphic design industry (GDI). It focuses on owner managers’ within the Creative Industries by understanding the use of sustainability and expresses what sustainability means for GDI owner managers’. Sustainability is and will be a relevant and unperfected accessed area of research, precisely because the rearrangement of resource saving and sustainable economic management is believed to be one of the major challenges of the 21st-century. Also the group of well the people with a Lifestyle Of Health And Sustainability continues to increase. Sustainability is a mega trend! It is well documented that sustainability management is especially relevant for big firms and is able to assure companies success for the long-term. This research seeks to explore this for small and medium sized companies. Which options do the mainly small organised German graphic design industry (GDI) have? How does that fit to the creative industry (CI) as a major economic force? The German GDI is rumoured to be very innovative – multiplied effective ideas are a basis for successful sustainability management. GDIs should be at the forefront of sustainability management because they have a wide reach and connections to other industries and are with its creativity services in graphic and communication design important for the growth of the whole German economy. The primary question is: Is the use of sustainability in German GDI a contribution to long-term success? This leads to the title of the thesis “An examination of owner managers’ perception of sustainability as a contribution to long-term success in the German graphic design industry.” The key research question is: Is the use of sustainability in German GDI a contribution to long-term success? The research methodology is based on a number of expert interviews conducted Metje Rocklage II with German graphic design industry owner managers’ implementing sustainability in their daily business. Preparing these semi-structured guideline interviews two pre talks were adapted. Together with reflective presentation of the author in front of an audience of graphic design and sustainability experts, the author developed a constructivist prejudice as a foundation for an Applied Thematic Analysis. The core results of this research are: Sustainability for graphic design industry owner managers’ means a strong inner motivated world improvement with another way of thinking and acting of how to ecologically (with priority), social and (not for all) economically produces good and sustainable results, which means durable and valuable products. The use of sustainability within German graphic design owner managers’ is based on internal motivation and personal core values. Ecologic activities occur more often than economic and social activities. Implementing sustainability to future business requires a creative, alternative, complex, and long-term thought process with consideration to consequences. Sustainability is often seen as a contribution to long-term success (with happiness and satisfaction). Sustainability positive influences the inner motivation, the networking and cooperation, is an added value, provides a unique selling proposition, and is seen as an image-forming factor. The surprising outcome of this research is the high personal inner motivation of the topic sustainability within German graphic design industry. The owner managers’ personal core values are of primary importance; with it the use of sustainability is seen as a contribution to long-term success with happiness and satisfaction. For long-term success, it seems to be optimal for the entrepreneur to act in a sustainable manner on the basis of inner motivation and intrinsic interest. That leads to the assumption, that the integration of sustainability in businesses of German graphic design owner managers’ is established on the basis of inner motivation and personal core values. German graphic designers that implement sustainability are headed in the right direction to be fit for the future, by thinking creative, complex and for the longterm. Further additional research is needed about inner motivation and sustainability as a contribution to small and medium-sized success

Synthesis and reactivity of early transition metal complexes containing multiple metal to carbon, nitrogen, or oxygen bonds

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Chemistry, 1982.MICROFICHE COPY AVAILABLE IN ARCHIVES AND SCIENCEVita.Includes bibliographical references.by Scott M. Rocklage.Ph.D

The weighting of positive vs. negative valence and its impact on the formation of social relationships

Forming social relationships is an integral aspect of our lives and a topic fundamental to social psychology. Using a performance-based measure of individual differences in valence weighting, we demonstrate that the extent to which first-year college students weight positive versus negative valence when engaged in attitude generalization predicts how many peer relationships they develop during the subsequent two months (Study 1). Furthermore, we show that individuals strategically recruited for their high sensitivity to interpersonal rejection benefit from an intervention that recalibrates their valence-weighting tendencies from an overweighting of negative valence to a more balanced weighting of positive and negative valence (Study 2). Recalibration led to extended decreases in participants' rejection sensitivity and, most importantly, led them to develop more social relationships over a subsequent two-week period. These findings demonstrate that the weighting of positive versus negative valence is a fundamental process that influences complex social outcomes and that such valence weighting tendencies can be recalibrated so as to benefit individuals

Habitat Evaluation Procedures (HEP) Report; Sandy River Delta, Technical Report 2000-2002.

Land managers are often challenged with the mandate to control exotic and invasive plant species. Reed canarygrass (Phalaris arundinacea) and Himalayan blackberry (Rubus discolor) are 2 such species that are currently threatening natural areas in western United States. Reed canarygrass may be native to the inland northwest (Antieau 2000), but it has invaded many wetland areas as dense, monoculture stands. Spread of this plant species is largely attributed to human disturbances, e.g., draining, farming (Antieau 2000). Reed canarygrass often dominates other emergent vegetation such as cattail (Typha spp.) and bulrush (Scirpus spp.) (Whitson et al. 1996, Apfelbaum and Sams 1987), and the resulting habitat is largely unsuitable for wetland birds. Himalayan blackberry was introduced to the United States as a garden shrub and was planted at wildlife-management areas for food and cover. It easily colonizes disturbed places, such as roadsides, ditches, and flood plains (Hoshovsky 2000). Once established, it forms a thick, impenetrable stand, which excludes native shrub species. Although Himalayan blackberry does provide food and cover for wildlife, particularly during fall and winter, it decreases habitat diversity, and therefore, may decrease wildlife diversity. Furthermore, patterns of avian nest predation may be altered in some exotic-shrub communities (Schmidt and Whelan 1999). For land managers to make sound decisions regarding invasive-plant control, it is useful to obtain information on current plant distributions in relation to targeted wildlife species, and then use models to predict how those species may respond to changes in vegetation. The Habitat Evaluations Program was developed by the U.S. Fish and Wildlife Service to evaluate current and future habitat conditions for fish and wildlife (Stiehl 1994). The program is based on Habitat Suitability Index (HSI) models for specific wildlife species. Each model contains several variables that represent life requisites (e.g., food and nesting cover) for that species. These variables are evaluated with vegetation sampling, and/or through the interpretation of aerial photographs and the like. Variable values are assigned a numerical score. The score may be based on a categorical rating (e.g . , different vegetation types receive different scores based on their importance for that species) or may be the result of a linear relationship (e.g., the score increases with the variable value; Figure 1). Variable scores are then input into a mathematical formula, which results in an HSI score. The HSI score ranges from 0-1, with 0 representing poor-quality habitat and 1 optimal habitat. HSI models assume a positive, linear relationship between wildlife-species density and the HSI score. For example, with an HSI score of 1, we assume that a species will be present at its highest density. Models can be projected into the future by changing variable values and observing the corresponding changes in HSI scores. Most models are relatively simple, but some are complex. These models have come under considerable scrutiny in the last several years, particularly concerning the validity of model assumptions (Van Horne 1983, Laymon and Barrett 1986, Hobbs and Hanley 1990, Kellner et al. 1992). Regardless of criticisms, these models may be used with success when there is an understanding and acceptance of model limitations. Each model should be evaluated as to its applicability in a given situation. Model validation, where results have on-the-ground verification, is highly recommended. Specific objectives of this project were to (1) conduct avian surveys and measure the present vegetation at the Sandy River Delta, (2) input the vegetation data into HSI models for 5 avian species, (3) evaluate the current habitat suitability for these species, and (4) predict species responses to potential changes in vegetation, resulting from the removal of reed canarygrass and/or Himalayan blackberry

From trust in caregivers' support to exploration : the role of openness to negative affect and self-regulation

Attachment theory assumes that trust in caregivers' support and exploration are closely related. Little research tried to investigate this link, nor focuses on mechanisms that might explain this association. The present studies examined whether trust is related to exploration through a serial indirect effect of openness to negative affect and self-regulation. In Study 1, 212 children, aged 8-13, completed questionnaires assessing trust, openness to negative affect, self-regulation and exploration. The results showed that trust predicted exploration, but only to the extent to which openness to negative affect and self-regulation were involved too. Study 2 refined these findings (n = 59, aged 9-12) using a behavioral measure of openness to negative affect and exploration, and with mother-reported self-regulation. Replicating this serial indirect effect of openness to negative affect and self-regulation with multiple informants and methods, the present studies advance our understanding of how trust might foster exploration in preadolescence

Fall Chinook Salmon Spawning Ground Surveys in the Snake River Basin Upriver of Lower Granite Dam, 2004 Annual Report.

Redd counts were used to document the spawning distribution of fall Chinook salmon (Oncorhynchus tshawytscha) in the Snake River basin upriver of Lower Granite Dam. The first reported redd counts were from aerial searches conducted intermittently between 1959 and 1978 (Irving and Bjornn 1981, Witty 1988; Groves and Chandler 1996)(Appendix 1). In 1986, the Washington Department of Fish and Wildlife began an annual monitoring program that, in addition to the Snake River, included aerial searches of the Grande Ronde River the first year (Seidel and Bugert 1987), and the Imnaha River in subsequent years (Seidel et al. 1988; Bugert et al. 1989-1991; Mendel et al. 1992). The U.S. Fish and Wildlife Service and Idaho Power Company began contributing to this effort in 1991 by increasing the number of aerial searches conducted each year and adding underwater searches in areas of the Snake River that were too deep to be searched from the air (Connor et al. 1993; Garcia et al. 1994a, 1994b, 1996-2004; Groves 1993; Groves and Chandler 1996). The Nez Perce Tribe added aerial searches in the Clearwater River basin beginning in 1988 (Arnsberg et. al 1992), and the Salmon River beginning in 1992. Currently searches are conducted cooperatively by the Nez Perce Tribe, Idaho Power Company, and U. S. Fish and Wildlife Service. Our objective for this report was to consolidate the findings from annual redd searches into a single document, containing detailed information about the searches from the most recent spawning season, and summary information from previous years. The work conducted in 2004 was funded by the Bonneville Power Administration, Idaho Power Company, and Bureau of Land Management

Fall Chinook Salmon Spawning Ground Surveys in the Snake River Basin Upriver of Lower Granite Dam, 2005 Annual Report.

Redd counts are routinely used to document the spawning distribution of fall Chinook salmon (Oncorhynchus tshawytscha) in the Snake River basin upriver of Lower Granite Dam. The first reported redd counts were from aerial searches conducted intermittently between 1959 and 1978 (Irving and Bjornn 1981, Witty 1988; Groves and Chandler 1996)(Appendix 1). In 1986, the Washington Department of Fish and Wildlife began an annual monitoring program that, in addition to the Snake River, included aerial searches of the Grande Ronde River the first year (Seidel and Bugert 1987), and the Imnaha River in subsequent years (Seidel et al. 1988; Bugert et al. 1989-1991; Mendel et al. 1992). The U. S. Fish and Wildlife Service and Idaho Power Company began contributing to this effort in 1991 by increasing the number of aerial searches conducted each year and adding underwater searches in areas of the Snake River that were too deep to be searched from the air (Connor et al. 1993; Garcia et al. 1994a, 1994b, 1996-2005; Groves 1993; Groves and Chandler 1996). The Nez Perce Tribe added aerial searches in the Clearwater River basin beginning in 1988 (Arnsberg et. al 1992), and the Salmon River beginning in 1992. Currently searches are conducted cooperatively by the Nez Perce Tribe, Idaho Power Company, and U.S. Fish and Wildlife Service. Our objective for this report was to consolidate the findings from annual redd searches into a single document, containing detailed information about the searches from the most recent spawning season, and summary information from previous years. The work conducted in 2005 was funded by the Bonneville Power Administration and Idaho Power Company