A Preliminary Qualitative Evaluation of the Virginia Gold Quality Improvement Program

Certified nursing assistants (CNAs) perform an important role in the long-term care system because they provide the majority of paid care to nursing facility residents. Unfortunately, annual CNA turnover often exceeds 100 percent nationally. Many factors account for this, including stressful working conditions, low pay, and limited benefits. The end result of high turnover is compromised continuity of care for residents, which often leads to poor quality and substandard care. In an effort to improve quality of care and staffing, the Virginia Department of Medical Assistance Services in 2009 implemented a pilot program, known as the Virginia Gold Quality Improvement Program, which provided funding to five nursing facilities to develop projects that improved working conditions for CNAs. This study presents the results of an evaluation performed on the program toward the end of its first year using 10 CNA and resident focus groups. Eight themes emerged from the focus groups, suggesting that both quality of care and working conditions improved in the pilot facilities after the program was implemented. However, these findings are preliminary and additional research is needed to more fully understand how the program influenced conditions in the pilot facilities

An Evaluation of Virginia Gold: A Medicaid Program to Improve Nursing Facility Quality of Care

A qualitative case study design employing focus groups was used to evaluate certified nursing assistant (CNA) (n = 26) and resident (n = 30) perceptions of the Virginia Gold Quality Improvement Program, a Medicaid funded 2-year quality improvement intervention piloted in five nursing facilities. As part of the program, the nursing facilities implemented quality improvement projects to develop supportive work environments in an effort to reduce CNA turnover and improve quality of care. Overall, the focus group participants viewed Virginia Gold positively and reported that CNA turnover decreased, while care quality improved during the program. These findings are supported by a previous Virginia Gold evaluation as well as by the results from a quantitative analysis of nursing facility CNA turnover and quality of care data and interviews with selected nursing facility management staff (n = 7) 1-year following the program’s culmination. A key finding from the management interviews is that the quality improvement projects became self-sustaining over time allowing all five nursing facilities to continue the projects without state funding

New Hampshire\u27s idle farm land, Station Bulletin, no.399

The Bulletin is a publication of the New Hampshire Agricultural Experiment Station, College of Life Sciences and Agriculture, University of New Hampshire, Durham, New Hampshire

Farm size and the capital acquisition problem on New Hampshire farms, Station Bulletin, no.457

The Bulletin is a publication of the New Hampshire Agricultural Experiment Station, College of Life Sciences and Agriculture, University of New Hampshire, Durham, New Hampshire

CORRELATION BETWEEN FUNCTIONAL CLASSIFICATION AND KINEMATICAL VARIABLES IN ELITE WHEELCHAIR RUGBY PLAYERS

Wheelchair rugby is a Paralympic team sport for athletes with disabilities affecting the four limbs. Players are classified according to their functional level from 0.5 (lowest function) to 3.5 (highest function). A player’s classification is based on muscle tests designed to evaluate the strength and range of motion of the upper limbs and trunk and also includes observation of the athlete on court (IWRF, 2008). Although the sport class is based on movement potential associated with neuromuscular function and performance of tasks related to the sport, it is not well known how functional classification in rugby correlates with variables strongly related to performance such as distance covered. In a previous investigation (Sarro et al., 2010), kinematical variables were analyzed in an international rugby competition and suggested a relation between functional classification and distance covered during the game. To further examine this relationship, this project aimed to investigate the correlation between functional classification and player physical performance as measured by distance covered during a game. In addition, the correlation was examined for each game quarter and as a function of velocity range

CORRELATION BETWEEN FUNCTIONAL CLASSIFICATION AND KINEMATICAL VARIABLES IN ELITE WHEELCHAIR RUGBY PLAYERS

Wheelchair rugby is a Paralympic team sport for athletes with disabilities affecting the four limbs. Players are classified according to their functional level from 0.5 (lowest function) to 3.5 (highest function). A player’s classification is based on muscle tests designed to evaluate the strength and range of motion of the upper limbs and trunk and also includes observation of the athlete on court (IWRF, 2008). Although the sport class is based on movement potential associated with neuromuscular function and performance of tasks related to the sport, it is not well known how functional classification in rugby correlates with variables strongly related to performance such as distance covered. In a previous investigation (Sarro et al., 2010), kinematical variables were analyzed in an international rugby competition and suggested a relation between functional classification and distance covered during the game. To further examine this relationship, this project aimed to investigate the correlation between functional classification and player physical performance as measured by distance covered during a game. In addition, the correlation was examined for each game quarter and as a function of velocity range

Reinterpreting Historical Data for Evidence-Based Shrubland Management

Long-term vegetation dynamics in the Chihuahuan Desert of southern New Mexico have been intensively studied for over a century, and interpretations of the broad scale drivers of these dynamics are numerous. We now understand that interpretation of spatially heterogeneous change requires a more nuanced, contextualized, and detailed understanding of edaphic features and landscape characteristics. Recently, state and transition models (STMs) have been employed to represent landscape-specific dynamics for each ecological site within a Major Land Resource Area (MLRA). We re-examined data characterizing vegetation across the public lands of the northern Chihuahuan Desert at two points in time, the 1930s and 2005. In this study, our objectives were to (1) develop geospatial data layers of historical and current vegetation states, (2) compare vegetation states between the 1930s and 2005 where the two data layers overlap, and (3) interpret any major vegetation state changes over this ~70 year period within the context of specific ecological sites. It was our hypothesis that ecological dynamics would vary in interpretable ways among ecological sites. Three primary observations are drawn from our results: (1) the bulk of the region was relatively stable during this period, (2) approximately the same amount of area experienced increased grass dominance as experienced increased shrub dominance, and (3) dynamics are strongly influenced by the properties of specific ecological sites. Major vegetation state changes, involving either increased grass dominance or increased shrub dominance, only occurred to any extent in 11 of 18 ecological sites within this study area. More important to management, significant increases in shrubs occurred within only four ecological sites. These sites were sandy, deep sand, shallow sandy, and gravelly sand. All other ecological sites within this region were relatively stable over the ~70 year period between observations. The obvious management implication is the importance of stratifying by ecological site prior to application of shrub control treatments

KINEMATIC PROFILE OF THE ELITE HANDCYCLIST

A handcycle is a relatively new sports equipment that is a combination of the traditional race wheelchair and a hand operated bicycle crank (Abel, Schneider, Platen, & Struder, 2006). The high mechanical efficiency of this geared fixed-frame racing cycle in comparison to a manual wheelchair can potentially increase the distance a person with a loss of lower limb function can travel. To guide the optimal setup for the handcyclist the influence of crank length (Goosey-Tolfrey, Alfano, & Fowler, 2008; Kramer, Hilker, & Bohm, 2009) and crank configuration (Faupin, Gorce, Meyer, & Thevenon, 2008a; Mossberg, Willman, Topor, Crook, & Patak, 1999) have been investigated. Actual neither research has been done on the upper body kinematics of elite athletes nor on relations between kinematics and performance. The aim of this study was to provide first sport specific information in this area with regards to athletes competing at an international level

Recent Optical and SEM Characterization of Genesis Solar Wind Concentrator Diamond on Silicon Collector

One of the 4 Genesis solar wind concentrator collectors was a silicon substrate coated with diamond-like carbon (DLC) in which to capture solar wind. This material was designed for analysis of solar nitrogen and noble gases [1, 2]. This particular collector fractured during landing, but about 80% of the surface was recovered, including a large piece which was subdivided in 2012 [3, 4, 5]. The optical and SEM imaging and analysis described below supports the subdivision and allocation of the diamond-on-silicon (DOS) concentrator collector

Cystic lymphangioma of the lesser sac presenting as acute appendicitis: A case report

Intra-abdominal lymphangiomas usually present by 2 years of age and are uncommon in adults. Cystic lymphagiomas arising from the lesser sac are even more uncommon. We report an unusual case of a lesser sac cystic lymphangioma presenting as acute appendicitis. A 21 year old female was admitted with pyrexia, right iliac fossa tenderness and an elevated C-reactive protein (CRP). At laparotomy, a large fluid filled cystic lesion was observed occupying the right side of the abdominal cavity. The lesion was excised in its entirety and histological diagnosis confirmed lymphangioma. The patient remains well with no evidence of recurrence 1 year post resection