Blueprint for the Dissemination of Evidence-Based Practices in Health Care

Proposes strategies for better dissemination of best practices through quality improvement campaigns, including campaigns aligned with adopting organizations' goals, practical implementation tools and guides, and networks to foster learning opportunities

A UV to Mid-IR Study of AGN Selection

We classify the spectral energy distributions (SEDs) of 431,038 sources in the 9 sq. deg Bootes field of the NOAO Deep Wide-Field Survey (NDWFS). There are up to 17 bands of data available per source, including ultraviolet (GALEX), optical (NDWFS), near-IR (NEWFIRM), and mid-infrared (IRAC/MIPS) data, as well as spectroscopic redshifts for ~20,000 objects, primarily from the AGN and Galaxy Evolution Survey (AGES). We fit galaxy, AGN, stellar, and brown dwarf templates to the observed SEDs, which yield spectral classes for the Galactic sources and photometric redshifts and galaxy/AGN luminosities for the extragalactic sources. The photometric redshift precision of the galaxy and AGN samples are sigma/(1+z)=0.040 and sigma/(1+z)=0.169, respectively, with the worst 5% outliers excluded. Based on the reduced chi-squared of the SED fit for each SED model, we are able to distinguish between Galactic and extragalactic sources for sources brighter than I=23.5. We compare the SED fits for a galaxy-only model and a galaxy+AGN model. Using known X-ray and spectroscopic AGN samples, we confirm that SED fitting can be successfully used as a method to identify large populations of AGN, including spatially resolved AGN with significant contributions from the host galaxy and objects with the emission line ratios of "composite" spectra. We also use our results to compare to the X-ray, mid-IR, optical color and emission line ratio selection techniques. For an F-ratio threshold of F>10 we find 16,266 AGN candidates brighter than I=23.5 and a surface density of ~1900 AGN per deg^2.Comment: Submitted to ApJ, 35 pages, 17 figures, 2 table

The Impact of Welfare Reform on Rural Alabamians

This exploratory study compared Alabama welfare leavers from two types of rural counties with those from two types of metropolitan counties. It was based on telephone interviews conducted during the summer of 1999 with a random sample of 4 16 people who had left TANF between July and November 1998. There were no statistically significant differences among leavers by county type in the likelihood they were employed and, if employed, in the rate of pay, number of hours worked weekly, or the types of benefits available at the job. Although many respondents no longer received benefits they had received while on TANF (Medicaid, Food Stamps, help receiving child support), county type was unrelated to losing such benefits. There was some suggestion that those residing in persistent poverty counties might have a harder time reaching self sufficiency that those residing in other rural counties. These results must be interpreted with caution due to the exploratory nature ofthe study and the relatively positive economic climate existing when the data were gathered

Unsuspected infection is infrequent in asymptomatic outpatients with refractory ascites undergoing therapeutic paracentesis

Large-volume paracentesis is a safe and effective means of treating patients with refractory ascites. However, there is limited information regarding the need for ascitic fluid studies in asymptomatic outpatients presenting for therapeutic paracentesis. The aim of this prospective study was to define the incidence and natural history of peritoneal fluid infection in asymptomatic outpatients undergoing therapeutic paracentesis. Methods : Over a 13-month period, 118 therapeutic paracenteses were performed in 29 outpatients with decompensated cirrhosis (Child-Pugh class B = 38%, C = 62%). After a brief medical history and physical examination, ascitic fluid cell count with differential and culture were obtained from all participating subjects. Seven (24%) of the subjects were receiving norfloxacin prophylaxis, accounting for antibiotic coverage during 40% of the procedures performed. The clinical course and outcome of study subjects during a mean follow-up of 137 days was reviewed. Results : All 118 (100%) of the ascitic fluid samples demonstrated absolute neutrophil counts of <250/mm 3 (mean = 6.5 ± 22.5 pmn/mm 3 ). Asymptomatic bacterascites was identified from three of the 118 (2.5%) fluid samples, but all of these subjects spontaneously recovered without treatment or sequelae. During follow-up, six episodes of symptomatic or hospital-associated peritoneal fluid infection were identified in study participants, emphasizing the importance of fluid studies in other clinical settings. Conclusion : Although further studies are needed, the routine culture of ascitic fluid in asymptomatic outpatients with refractory ascites requiring therapeutic paracentesis may not be necessary when there is a low index of suspicion for occult infection. In circumstances of clinical uncertainty, however, obtaining ascitic fluid cell counts with differential is recommended to insure patient safety.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73079/1/j.1572-0241.1999.01445.x.pd

Setting school-level outcome standards

To establish international standards for medical schools, an appropriate panel of experts must decide on performance standards. A pilot test of such standards was set in the context of a multidimensional (multiple-choice question examination, objective structured clinical examination, faculty observation) examination at 8 leading schools in China. Methods  A group of 16 medical education leaders from a broad array of countries met over a 3-day period. These individuals considered competency domains, examination items, and the percentage of students who could fall below a cut-off score if the school was still to be considered as meeting competencies. This 2-step process started with a discussion of the borderline school and the relative difficulty of a borderline school in achieving acceptable standards in a given competency domain. Committee members then estimated the percentage of students falling below the standard that is tolerable at a borderline school and were allowed to revise their ratings after viewing pilot data. Results  Tolerable failure rates ranged from 10% to 26% across competency domains and examination types. As with other standard-setting exercises, standard deviations from initial to final estimates of the tolerable failure rates fell, but the cut-off scores did not change significantly. Final, but not initial cut-off scores were correlated with student failure rates ( r =  0.59, P  = 0.03). Discussion  This paper describes a method to set school-level outcome standards at an international level based on prior established standard-setting methods. Further refinement of this process and validation using other examinations in other countries will be needed to achieve accurate international standards.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71572/1/j.1365-2929.2005.02374.x.pd

Pluto's extended atmosphere: An escape model and initial observations

We have calculated the rates of production and hydrodynamic outflow of atomic hydrogen resulting from the photodissociation of methane in the upper atmosphere of Pluto. Under the present near-perihelion conditions this yields an extended cloud of H around Pluto which is likely to be the most easily observable signature of Pluto's extended atmosphere, and thereby provide information on the extent, escape rate, and composition of Pluto's upper atmosphere. We have also performed initial observations with the IUE attempting to detect the H Ly [alpha] emission from the extended H cloud, which we use to derive upper limits to the cloud properties as a function of the cloud extent.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30226/1/0000618.pd

Photometry of Kuiper belt object (486958) Arrokoth from New Horizons LORRI

On January 1st 2019, the New Horizons spacecraft flew by the classical Kuiper belt object (486958) Arrokoth (provisionally designated 2014 MU69), possibly the most primitive object ever explored by a spacecraft. The I/F of Arrokoth is analyzed and fit with a photometric function that is a linear combination of the Lommel-Seeliger (lunar) and Lambert photometric functions. Arrokoth has a geometric albedo of p_v = 0.21_(−0.04)^(+0.05) at a wavelength of 550 nm and ≈0.24 at 610 nm. Arrokoth's geometric albedo is greater than the median but consistent with a distribution of cold classical Kuiper belt objects whose geometric albedos were determined by fitting a thermal model to radiometric observations. Thus, Arrokoth's geometric albedo adds to the orbital and spectral evidence that it is a cold classical Kuiper belt object. Maps of the normal reflectance and hemispherical albedo of Arrokoth are presented. The normal reflectance of Arrokoth's surface varies with location, ranging from ≈0.10–0.40 at 610 nm with an approximately Gaussian distribution. Both Arrokoth's extrema dark and extrema bright surfaces are correlated to topographic depressions. Arrokoth has a bilobate shape and the two lobes have similar normal reflectance distributions: both are approximately Gaussian, peak at ≈0.25 at 610 nm, and range from ≈0.10–0.40, which is consistent with co-formation and co-evolution of the two lobes. The hemispherical albedo of Arrokoth varies substantially with both incidence angle and location, the average hemispherical albedo at 610 nm is 0.063 ± 0.015. The Bond albedo of Arrokoth at 610 nm is 0.062 ± 0.015

Maine’s Winter Roads: Salt, Safety, Environment and Cost

This report summarizes key findings from a yearlong study of the issues and practices in winter maintenance of Maine’s roads