Indicators of prescribing quality in drug utilisation research: report of a European meeting (DURQUIM, 13-15 May 2004)

An invitational expert meeting on indicators of prescribing quality was held on 13-15 May 2004, bringing together-from 19 European countries, the US, Canada, and Australia-40 researchers specialized in the development and application of indicators. The meeting was organized by the European Drug Utilization Research Group (EuroDURG), the Belgian National Health Insurance Institute (RIZIV-INAMI), and the World Health Organisation Regional Office for Europe (WHO-Euro). The field of prescribing quality was defined and delineated from the medical error field. A conceptual grid for classifying quality indicators was discussed, combining two axes (a drug/disease/patient axis and a structure/process/outcome axis). In addition, available databases were listed for continuous monitoring of drug utilization in Europe, with a description of the content and the richness of the collected data, as well as the impact on the potential and limitations to develop quality indicators. The importance of the origin of data for validity assessment was stressed, as data on drug utilization may originate from physician sources (prescribing data), from pharmacist or health insurer sources (distribution data), or directly from patient sources (compliance data). The different aspects of validity and their methods of assessment were listed. An overview of the (in)appropriate uses of indicators was given. The state of the art of the development and application of prescribing quality indicators in all represented countries was made, together with a first draft of a database of prescribing quality indicators, already subjected to validation procedures

Development of a Next-Generation Non-Proprietary Portable Concrete Barrier

Portable concrete barriers (PCBs) are segmented barriers made of precast concrete units that are connected by various load-bearing hardware. PCBs are typically used to shield work zones by redirecting errant vehicles upon impact with the barrier system. Most commonly-available PCBs have demonstrated performance issues arising from the sloped face of the barrier, which encourages vehicles to pitch and roll during impact, potentially resulting in vehicle rollover. Concerns also exist regarding the large dynamic deflections exhibited by these systems that can encroach upon the protected work zone or require anchoring to prevent large displacements. In addition to these concerns, the American Association of State Highway and Transportation Officials (AASHTO) updated the Manual for Assessing Safety Hardware (MASH) in 2016, which improved the criteria for evaluating roadside safety devices and required the re-evaluation of barrier systems developed before the updated standards were published. Thus, an opportunity existed to develop a next-generation PCB system capable of meeting the new MASH 2016 criteria while addressing the concerns of the current generation of PCBs. The objective of this research effort funded by the Mid-America Transportation Center (MATC) was to further develop and investigate PCB concept designs that were brainstormed under a parallel research effort at the Midwest Roadside Safety Facility (MwRSF) funded by the Wisconsin Department of Transportation. This research consisted of the development of finite element models of the PCB design concepts for use in LS-DYNA simulations, followed by the comparison of the simulation results to a current PCB system that has been previously modeled and validated. The simulation analysis identified three PCB concepts as viable designs, while three other PCB concepts were not recommended based on the simulation performance. Upon completion of the simulation analysis, the simulation results of the six PCB concepts were presented to Midwest Pooled Fund Program member states. Finally, a single concept, that used interlocking and staggered precast concrete segments without the need for connection hardware, was selected for further design and full-scale crash testing in the next phase of the research. Advisor: Mojdeh A. Pajou

Landscape Structure and Dynamics of Recreational Fisheries

Angler populations and the waterbodies they use are patchily distributed, creating putatively complex user-resource dynamics on the landscape. Spatially and temporally dynamic relationships between anglers and waterbodies can be difficult to track, understand, and manage. We often focus our efforts on the angler (directly or indirectly) with far less attention devoted to understanding the spatial structure and dynamics of fisheries on the landscape. Waterbodies serve as dynamic attractors on the landscape, shaping landscape patterns in angler participation. We surmise that by understanding the spatial structure and dynamics of recreational fisheries we can gain tremendous insight to cross-scale patterns that shape angler behavior. We constructed waterbody-specific “anglersheds” that reveal critical links between anglers (i.e., users) and waterbodies (i.e., resources) on the landscape. Anglersheds represent the area of influence or spatiotemporal draw of anglers to a waterbody. Anglersheds were constructed from frequencies of anglers’ zip codes that were collected during on-site interviews (April-October 2014-2017) at eight prominent Nebraska waterbodies. We used these anglersheds to visually depict the spatiotemporal structure and dynamics of these recreational fisheries at multiple spatial scales and temporal levels. We then quantified these spatiotemporal dynamics by extracting multiple anglershed metrics. Anglersheds were dynamic in both space and time; anglershed features such as anglershed area (i.e., size), the degree of fragmentation (i.e., number of patches), and compactness (i.e., angler density) also differed among waterbodies. We then selected 11 independent variables that encompassed variation in the spatial socioeconomic structure, on-site attributes, and angler heterogeneity to explain changes in anglershed area for seven prominent Nebraska waterbodies. Anglershed area exhibited a positive relationship with air temperature, wind speed, and population density, but was unrelated to angler effort, catch rate, fuel price, household income, party size, precipitation, trip days, and waterbody size. Anglersheds have the potential to “unlock” a wealth of information concerning the underlying spatial structure and dynamics of recreational fisheries. This approach has the ability to expose and capture cross-scale interactions within coupled social-ecological systems. Advisors: Mark A. Kaemingk and Kevin L. Pop

Larval Fish Abundance in the Benthic and Surface Drift of the Missouri River

Knowledge of the larval fish community of the Missouri River is one of the biggest gaps in fisheries research. The Nebraska Game and Parks Commission has sampled the drift of the Missouri River for many years (1983-2015), but these data have not been compiled into a unified assessment. Therefore, the objectives of this study were to: 1) quantify temporal and spatial aspects of larval fish community composition (richness) and structure (abundance) of the surface drift, 2) quantify associations of larval fish communities of the drift to different discharges of the Missouri River, 3) quantify the larval benthic drift community, and 4) document evidence of natural spawning and fertilization success by Pallid Sturgeon Scaphirhynchus albus through capture of free embryos entering the drifting phase in the Nebraska portion of the Lower Missouri River. For the surface drift portion of this thesis, there were nine sites from four segments used for these analysis. The greatest overall abundance occurred in 2000 (2.036 fish/m3, SE=0.122), with Sciaenidae, (N = 155,400) being the most abundant. There were either no significant trends or declining trends in relative abundance over time for all sites and families except for Clupeidae at St. Helena. When comparing segments, similar results were noted with only three segment/family combinations yielding a positive trend (Catostomidae (Segment 1), Cyprinidae (Segment 3), and Percidae (Segment 3)). Analysis of similarity (ANOSIM) found Segment 1 was dissimilar from Segment 2, Segment 3, and Segment 4. Post hoc similarity percentage (SIMPER) analysis displayed that abundances of Sciaenidae across the segments was the reason for this difference. Annual discharge did not influence fish communities of the surface larval drift. The benthic fish community was sampled primarily at Nebraska City, NE (rkm 907.6), with limited sampling at Niobrara, NE. The most abundant family sampled in the benthic drift was Sciaenidae from the Nebraska City Site in 2015 (n=88) (0.008 fish/m3, SE+0.0027). One wild Pallid Sturgeon free embryo was captured on May 28, 2014 Sampling the larval fish drift provides insights on the overall health and productivity of the system and by assessing trends in the larval fish abundance of the drift annual variations and changes in recruitment can be detected. Advisor: Mark A. Peg

Your environment and you: investigating stress triggers and characteristics of the built environment

Master of Landscape ArchitectureDepartment of Landscape Architecture/Regional and Community PlanningBrent ChamberlainThe physical environment influences mental health and inevitably well-being. While exposure to natural environments shows salubrious health benefits among those who maintain a consistent connection, little is known about how urban environments impact mental health. As urbanization increases worldwide, it is essential to understand the linkages between urbanized environments and public health. This project is guided by the research question: How do different environmental characteristics affect stress-related responses in users? The study will guide individual subjects (n > 30) to walk a designated route, exposing them to different architectural and environmental elements in downtown Manhattan, Kansas. Physiological biofeedback sensors, including electrodermal activity (EDA) and heart rate sensors, will be used monitor physiological behavioral changes; GPS will provide spatial location; and a GoPro camera will provide real-time first-person experience. Data from these sensors will be integrated into a temporal-spatial analysis to ascertain correlations between architectural and environmental elements in space and associated stress responses. Upon completing the walk, participants will take a brief survey asking for their perceptions, both quantitatively and qualitatively, of the different environments they encounter on the walk. Raw data collected from the biofeedback devices will be refined and analyzed spatially using GIS mapping software. This will allow us to visualize any associations between design characteristics and the elicited behavioral responses in order to determine the environmental characteristics that may illicit heightened stress responses. Analysis of the survey data will seek to identify any correlations between physiological and perception-based responses. The intent of the research is to provide a foundation for further studies into how public policy can be better informed and augmented to mitigate potential public health issues caused by urban design. Results will also inform architectural and engineering decision-making processes to further improve urban design by identifying characteristics that may improve or decrease mental health of those living and/or frequenting urban environments