Investigating Compassion Fatigue and Burnout Rates Among Mental Health Professionals at Sioux Trails Mental Health Center

The purpose of this research is to explore the existence of compassion fatigue and burnout among mental health professionals at Sioux Trails Mental Health Center, which is a community based mental health center in located in various rural communities in Southern Minnesota. The research also sought to identify what the professional and agency can do to reduce burnout rates. Research Questions: Does compassion fatigue and burnout exist among the mental health professionals at Sioux Trails Mental Health Center? What professional and personal resources do the mental health professionals use to reduce the risk of compassion fatigue an burnout

Till-Like Deposits South of Kansas River in Douglas County, Kansas

The line marking the position of the maximum advance of the Kansan ice sheet in northeastern Kansas has been established by investigators at various places as lying either north or south of Kansas or Kaw River. The earlier maps show the drift border as being south of the river and extending at least as far south as 38° 50\u27 north latitude. Of the more recent work that done by Todd not only represents the latest but also the most thorough. This investigator locates the edge of the Kansan ice sheet as lying north of the Kaw River valley from a point midway between Lecompton and Lawrence to Kansas City, Kansas. See heavy continuous line, figure 1. This line separating the glaciated from the unglaciated area in Kansas is essentially the one adopted by the Kansas Geological Survey and published on its more recent maps

Beyond the Urban Fabric: Weaving Fiber into America's Rural Communities

Unfortunately, there is still a lack of research on the impacts of targeted municipal broadband investments. Because municipal fiber investments are expensive and take time to implement, it is important to understand how these investments translate to economic outcomes in the local labor force. Having a strong local labor force is crucial to economic development in small, rural towns to ensure these areas are not left behind in the digital divide. With a better understanding of how fiber investments translate to benefits for local workers, communities can make informed decisions about whether this type of infrastructure investment is worthwhile as a means to prevent the digital divide. In order to analyze whether municipal fiber investments are related to positive economic and labor force outcomes, this paper will focus on 73 municipalities in the US that have implemented municipal fiber optic networks. The analysis will focus on municipalities that invested in fiber networks between 2000-2011, in areas where networks are available to at least 80% of homes, businesses and institutions within their municipal boundaries. Specifically, I will examine select economic indicators that pertain to the labor force, such as median income, unemployment, percentage of people who work in business/professional services and the percentage of people who work from home, to assess whether positive economic outcomes accrue to local workers in towns that have made these municipal investments, relative to the larger geography of their respective counties. Additionally, given that some municipalities with these networks perform better than others in terms of the select indicators, I will attempt to unpack the performance of a few of the best-performing rural towns. This will bring more insight into whether external factors, such as incentivizing policies and institutional supports, are important to leveraging municipal fiber optic investments to build a robust economy and local workforce.Master of City and Regional Plannin

Nicht-keynesianische Effekte der Fiskalpolitik: Eine Übersicht

Keynesianisch orientierte Wirtschaftswissenschaftler gehen davon aus, dass fiskalische Impulse das durch eine schwache Binnennachfrage bedingte niedrige Wirtschaftswachstum anregen können. Sind jedoch auch negative Einkommenseffekte möglich? Welche nicht-keynesianischen Effekte der Fiskalpolitik sind aus den gängigen und aus den neuen Makromodellen abzuleiten? Wie wirken sich verzerrende Steuern, der Verschuldungsgrad und das Ausmaß der Fiskalpolitik aus? --

The Interpretation of Certain Leached Gravel Deposits in Louisa and Washington Counties, Iowa

During the field season of 1917, the writer examined two exposures of stratified sands and gravels, which, in age, may probably be correlated with the close of the Nebraskan stage of glaciation and with Aftonian times

A discrete random model describing bedrock profile abrasion

We use a simple, collision-based, discrete, random abrasion model to compute the profiles for the stoss faces in a bedrock abrasion process. The model is the discrete equivalent of the generalized version of a classical, collision based model of abrasion. Three control parameters (which describe the average size of the colliding objects, the expected direction of the impacts and the average volume removed from the body due to one collision) are sufficient for realistic predictions. Our computations show the robust emergence of steady state shapes, both the geometry and the time evolution of which shows good quantitative agreement with laboratory experiments.Comment: 9 pages, 6 figure

The Legacy of Leaded Gasoline in Bottom Sediment of Small Rural Reservoirs

The historical and ongoing lead (Pb) contamination caused by the 20th-century use of leaded gasoline was investigated by an analysis of bottom sediment in eight small rural reservoirs in eastern Kansas, USA. For the reservoirs that were completed before or during the period of maximum Pb emissions from vehicles (i.e., the 1940s through the early 1980s) and that had a major highway in the basin, increased Pb concentrations reflected the pattern of historical leaded gasoline use. For at least some of these reservoirs, residual Pb is still being delivered from the basins. There was no evidence of increased Pb deposition for the reservoirs completed after the period of peak Pb emissions and (or) located in relatively remote areas with little or no highway traffic. Results indicated that several factors affected the magnitude and variability of Pb concentrations in reservoir sediment including traffic volume, reservoir age, and basin size. The increased Pb concentrations at four reservoirs exceeded the U.S. Environmental Protection Agency threshold-effects level (30.2 mg kg-1) and frequently exceeded a consensus-based threshold-effects concentration (35.8 mg kg-1) for possible adverse biological effects. For two reservoirs it was estimated that it will take at least 20 to 70 yr for Pb in the newly deposited sediment to return to baseline (pre-1920s) concentrations (30 mg kg-1) following the phase out of leaded gasoline. The buried sediment with elevated Pb concentrations may pose a future environmental concern if the reservoirs are dredged, the dams are removed, or the dams fail

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe