Reducing No-Shows and Late Cancellations in Primary Care

No-shows and late cancellations are a challenge across medical practices, resulting in costly, fragmented care. Many patients do not understand the impact that not showing or cancelling an appointment less than 48 hours prior to a visit can have. While reminding the patient of the appointment has been a known tactic to improve patient’s attendance, the most effective mode of the reminder can vary significantly across patient populations. Just as critical as reminding the patient of the appointment is to ensure they understand the purpose of the visit along with showing respect for their time and any competing priorities. This quality improvement initiative aimed to reduce the no-show rate of 21.4% and late cancellation rate of 21.1% for the MassHealth population by 5%. Learning from previous studies, a hybrid approach to meet this population’s needs included a 7-day reminder call with a Patient Engagement Coordinator (PEC) and a 2-day automated reminder. During the 7-day reminder call the PEC identified barriers to attending the appointment through concrete planning and motivational interviewing strategies. Appointments were rescheduled as needed, additional information was provided to solidify shared goals for the visit, and patient’s time/obligations were validated. The intervention resulted in positive feedback from the majority of patients and revealed concrete planning prompts to be a very effective communication form. The post-intervention data analysis revealed both the no-show and late cancellation results were reduced for the MassHealth population. Due to data and confounding variable limitations this study is recommended to be a basis for future investigation as the principal investigators enter into the next pilot phase of this model

U.S. Immigration Policy: Family Reunification

This issue brief covers the 1965 Immigration Act, the preference category framework, the immigrant visa petition application and approval process. The author argues that family reunification is in jeopardy, and concludes with possible solutions and recommendations

Senior Thesis ST 2011-02

Agriculture in the Arctic is often limited by the low receipt of heat energy, which is often measured in growing degree days (GDD). With the advent of increasingly powerful climate modeling, projection and downscaling techniques, it is becoming possible to examine future climates in high resolution. Recent availability in Alaska has prompted interest in examining the distribution of current and the potential future of local agriculture. The goal of this study was to utilize Scenarios Network for Alaska Planning (SNAP) downscaled, ensemble projections to examine this in terms of GDDs in the Fairbanks North Star Borough of Alaska. Historic and projected monthly mean temperatures were utilized to calculate GDDs and then map the borough at a 4 km2 scale. Additionally, local agriculturalists were interviewed in order to put these theoretical calculations into context. Ultimately, projections of the examined agricultural locations showed an average of a 2% increase in GDD per decade and a 26% increase in GDDs from 1949 to 2099. This project indicated that the North Star Borough will receive increased heat energy due to climate change over the next century that may further enable increased yields and varieties of crops

Energy conversion apparatus Patent

Direct conversion of thermal energy into electrical energy using crossed electric and magnetic field

The Independent Counsel Statute and Questions About Its Future

Despite the divergence of opinion regarding the Ethics in Government Act, it appears there is a growing public consensus that the Act is genuinely and seriously flawed. Whether these flaws can be corrected is in serious doubt

Assessment of Haiti’s electricity sector

INTRODUCTION: This report summarizes the current state of the electricity sector in Haiti, to form a knowledge base from which to subsequently evaluate options for how best to increase electricity access in Haiti. Accordingly, this report summarizes the results of an extensive review of the publicly-available information on the electricity sector in Haiti, supplemented by targeted interviews with selected individuals known to be knowledgeable about electricity in Haiti based on their recent involvement in assessing the sector or in pursuing/supporting development opportunities. [TRUNCATED

Interventions for Helping Students at Risk of Dropping Out of School

Dimmitt and Hatch present a brief overview and analysis of the article, A tutorial and counseling program: Helping students at risk of dropping out of school, originally published in Professional School Counseling. The authors present a summary of the key components of the article including the introduction, method and results of the study. They offer an additional analysis of implications for future practice, including a discussion of the benefits of combining both a drop out prevention program with group counseling to improve student self esteem and academic achievement

Cross-species analysis traces adaptation of Rubisco towards optimality in a low dimensional landscape

Rubisco, probably the most abundant protein in the biosphere, performs an essential part in the process of carbon fixation through photosynthesis thus facilitating life on earth. Despite the significant effect that Rubisco has on the fitness of plants and other photosynthetic organisms, this enzyme is known to have a remarkably low catalytic rate and a tendency to confuse its substrate, carbon dioxide, with oxygen. This apparent inefficiency is puzzling and raises questions regarding the roles of evolution versus biochemical constraints in shaping Rubisco. Here we examine these questions by analyzing the measured kinetic parameters of Rubisco from various organisms in various environments. The analysis presented here suggests that the evolution of Rubisco is confined to an effectively one-dimensional landscape, which is manifested in simple power law correlations between its kinetic parameters. Within this one dimensional landscape, which may represent biochemical and structural constraints, Rubisco appears to be tuned to the intracellular environment in which it resides such that the net photosynthesis rate is nearly optimal. Our analysis indicates that the specificity of Rubisco is not the main determinant of its efficiency but rather the tradeoff between the carboxylation velocity and CO2 affinity. As a result, the presence of oxygen has only moderate effect on the optimal performance of Rubisco, which is determined mostly by the local CO2 concentration. Rubisco appears as an experimentally testable example for the evolution of proteins subject both to strong selection pressure and to biochemical constraints which strongly confine the evolutionary plasticity to a low dimensional landscape.Comment: http://www.pnas.org/content/107/8/3475.short http://www.ncbi.nlm.nih.gov/pubmed/20142476 http://www.weizmann.ac.il/complex/tlusty/papers/PNAS2010.pd