Alien Registration- Wylie, Mary E. (Brownville, Piscataquis County)

https://digitalmaine.com/alien_docs/10788/thumbnail.jp

Strategic Planning in Human Service Agencies

Recent public policy initiatives including deinstitutionalization, deregulation, decentralization, and privatization have resulted in: (a) rapid growth in the number of private not-for-profit organizations; and, (b) competitive environments. These conditions have forced agencies to examine their planning processes to determine if agency goals are appropriate for meeting market demands. An exploratory study of 154 human service agencies examined if and how strategic planning was used to respond to these conditions. The Chief Executive Officers for those agencies reported that strategic planning was replacing incremental planning as a preferred planning model. However, the choice resulted because of pressure from outside influentials not because of a perception of increased competition. Despite this, agencies choosing a strategic planning model were generally rigorous in its application. One-half of the sample reported a major change outcome for the agency as a result of the planning process but broad participation by stakeholders impeded substantial change. Questions are raised about using strategic planning when major change is not sought and/or broad participation by stakeholders is important

The Diagnostic Use of Alternate Samples in Forensic Toxicology

The use of biological specimens other than blood and urine for the detection of drugs, usually referred to as alternative specimens, has been the focus of many scientific studies over the past two decades. The type of biological sample analysed affects the type of information obtained and the aims of this project were to investigate hair, saliva and nail as alternative specimens and to evaluate their diagnostic use in Forensic Toxicology. The potential of hair analysis as a diagnostic tool in Forensic Toxicology was investigated by developing and validating a robust and reliable method for the simultaneous determination of opiates and methadone in hair samples. An assessment was made of the ability of three different pretreatment steps involving enzymatic hydrolysis, acid hydrolysis and solvent washing to extract morphine, codeine, 6-monoacetylmorphine, methadone and EDDP from hair. The methanol procedure was the only one that did not hydrolyse a percentage of 6-monoacetylmorphine to morphine and this was used for subsequent analyses, followed by solid phase extraction (SPE) and gas chromatography-mass spectrometry (GC/MS). Post-mortem hair samples from suspected heroin overdose cases were analysed using the validated method to determine whether each individual was a heroin user and their history of heroin exposure. An overall indication of drug use was produced for each individual from the results of analyses of hair and post-mortem blood. Known drug use history was established from police reports and the hair analysis results were evaluated against the available information. The ranges of concentrations of analytes found in hair were; morphine 0.10 - 9.79 ng/mg, codeine 0.12 - 3.47 ng/mg, 6-monoacetylmorphine 0.14 - 70.07 ng/mg, methadone 0.15 - 1.15 ng/mg and EDDP 0.27 - 1.55 ng/mg. A total of 31 hair samples was analysed, the majority of which were shown to be from regular heroin users. Criteria were established from the data which allowed users to be categorised into low, medium and high regular users with respect to their heroin habit. Periods of compliance with methadone programmes or drug rehabilitation programmes were also evident. The data supported the conclusion that hair analysis can successfully determine the drug use history of heroin users. The number of cases involving fluoxetine and paroxetine has increased in the last 5 years and has required the development of improved methods to quantitate these drugs in whole blood. In addition, blood analysis provides the reference data for evaluation of analytical results from alternative specimens. An SPE method using cyanopropyl columns was developed and evaluated initially for the extraction of fluoxetine and its metabolite, norfluoxetine. This method was compared with existing liquid-liquid extraction methods and validated using both high performance liquid chromatography (HPLC) and GC/MS. The HPLC method was found to work well with clinical blood samples but was subject to problems caused by co-extracted interferences from some post-mortem blood samples. By contrast, the GC/MS method did not exhibit this problem and was selected for further analyses. The method was validated for the simultaneous analysis of fluoxetine, norfluoxetine and paroxetine and was shown to achieve significantly improved limits of detection for each of these analytes of approximately 1 ng/ml. Post-mortem and clinical blood samples from antidepressant users were successfully analysed using this improved method, these results provided the foundation for further research into the diagnostic use of alternative biological specimens and were compared with data from hair, saliva and urine from the same cases. The method developed for antidepressants in blood was also found to extract these analytes efficiently from saliva. One conclusion from this study was that saliva can be used as an alternative specimen to blood or urine to indicate recent drug exposure. The analysis of hair as a means of determining chronic administration of prescription drugs was assessed by developing a procedure for the analysis of fluoxetine, norfluoxetine and paroxetine in hair samples obtained from geriatric and clinical patients. Methanol wash and acidic hydrolysis pre-treatments were assessed for these drugs. The latter produced higher recoveries without deterioration of the analytes and was used for analysis of hair samples from antidepressant users, to give a history of their drug administration, and these results were assessed against information obtained from each patient's medical records. (Abstract shortened by ProQuest.)

Longitudinal dynamics of skin bacterial communities in the context of Staphylococcus aureus decolonization

Decolonization with topical antimicrobials is frequently prescribed in health care and community settings to prevent Staphylococcus aureus infection. However, effects on commensal skin microbial communities remains largely unexplored. Within a household affected by recurrent methicillin-resistant S. aureus skin and soft tissue infections (SSTI), skin swabs were collected from the anterior nares, axillae, and inguinal folds of 14 participants at 1- to 3-month intervals over 24 months. Four household members experienced SSTI during the first 12-months (observational period) and were prescribed a 5-day decolonization regimen with intranasal mupirocin and bleach water baths at the 12-month study visit. We sequenced the 16S rRNA gene V1-V2 region and compared bacterial community characteristics between the pre- and post-intervention periods and between younger and older subjects. The median Shannon diversity index was stable during the 12-month observational period at all three body sites. Bacterial community characteristics (diversity, stability, and taxonomic composition) varied with age. Among all household members, not exclusively among the four performing decolonization, diversity was unstable throughout the year post-intervention. In the month after decolonization, bacterial communities were changed. Although communities largely returned to their baseline states, relative abundance of some taxa remained changed throughout the year following decolonization (e.g., more abundan

Short and long-term lifestyle coaching approaches used to address diverse participant barriers to weight loss and physical activity adherence

Background: Individual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a randomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers and the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform dissemination efforts. Methods: Lifestyle coaches documented barriers and approaches after each session (mean session attendance = 50.3 ± 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68% female, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage of the cohort for whom they applied. Barrier groupings were also analyzed in relation to baseline demographic characteristics. Results: Top weight loss barriers reported were problems with self-monitoring (58%); social cues (58%); holidays (54%); low activity (48%); and internal cues (thought/mood) (44%). Top activity barriers were holidays (51%); time management (50%); internal cues (30%); illness (29%), and motivation (26%). The percentage of the cohort having any type of barrier increased over the long-term intervention period. A majority of the weight loss barriers were significantly associated with younger age, greater obesity, and non-Caucasian race/ethnicity (p-values vary). Physical activity barriers, particularly thought and mood cues, social cues and time management, physical injury or illness and access/weather, were most significantly associated with being female and obese (p 90% long term) and regularly reviewed self-monitoring skills. More costly approaches were used infrequently during the first 16 sessions (≤10%) but increased over 3.2 years. Conclusion: Behavioral problem solving approaches have short and long term dissemination potential for many kinds of participant barriers. Given minimal resources, increased attention to training lifestyle coaches in the consistent use of these approaches appears warranted

Book reviews

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45572/1/11199_2004_Article_BF00287823.pd

American Cancer Society guidelines for breast cancer screening: update 2003

In 2003, the American Cancer Society updated its guidelines for early detection of breast cancer based on recommendations from a formal review of evidence and a recent workshop. The new screening recommendations address screening mammography, physical examination, screening older women and women with comorbid conditions, screening women at high risk, and new screening technologies

Centerscope

Centerscope, formerly Scope, was published by the Boston University Medical Center "to communicate the concern of the Medical Center for the development and maintenance of improved health care in contemporary society.

Evidence of tidal debris from Omega Cen in the Kapteyn Group

This paper presents a detailed kinematic and chemical analysis of 16 members of the Kapteyn moving group. The group does not appear to be chemically homogenous. However, the kinematics and the chemical abundance patterns seen in 14 of the stars in this group are similar to those observed in the well-studied cluster, Omega Centauri. Some members of this moving group may be remnants of the tidal debris of Omega Cen, left in the Galactic disk during the merger event which deposited Omega Cen into the Milky Way.Comment: 30 pages, 9 figures, 11 tables. Accepted for publication in A

Book reviews

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45645/1/11199_2004_Article_BF00287975.pd