A More Perfect Union: A National Citizenship Plan

A More Perfect Union: A National Citizenship Plan sets forth the resources, activities, and partnerships that would be required to naturalize as many eligible immigrants as possible. It calls for a national mobilization in support of citizenship, identifying the roles of government, immigrant service agencies, and other sectors of society in a coordinated plan. It describes a program that could serve as a linchpin of an emerging U.S. immigrant integration strategy.Access the complete report via the download link below. An executive summary and individual chapters may be downloaded at http://www.cliniclegal.org/DNP/citzplan.html

The Path to Integration: Meeting the Special Needs of Refugee Elders in Resettlement

Refugee elders in resettlement represent a small but very vulnerable population. Regardless of age, vitality, or employability, elders play a critical role in upholding a family strength and stability through the difficult period of forced migration. Yet, most resettlement countries provide few services to elders beyond those given to the whole family in the forms of housing, income support, and health care. The lack of elder-specific services may be the result of limited resettlement numbers, inadequate resources, or unfamiliarity with elders’ unique needs. This article discusses the many common needs and challenges of refugee elders through a literature review and follows with recommendations for interventions and integration activities. The authors suggest that skillful needs assessment and creative program design can help to restore elders’ dignity and vitality, thereby strengthening the family unit. The article is based on the authors’ experiences as technical assistance advisers to over 130 private and public refugee elder programs in the United States from 1997 to 2000.Dans le contexte de la réinstallation, les personnes âgées parmi les réfugiés constituent un segment de la population qui est petit, mais extrêmement vulnérable. Cependant, quels que soient leur âge, leur niveau de vitalité ou d’employabilité, les personnes du troisième âge ont un rôle essentiel à jouer pour la préservation de la vigueur et de la stabilité de la famille pendant la période difficile de migration forcée. En dépit de cela, la plupart des pays de réinstallation fournissent très peu de services aux personnes âgées en dehors de ce qui est fourni aux autres membres de la famille pour le logement, le soutien du revenu et les soins de santé. L’absence de services spécifiquement axés vers les personnes âgées pourrait s’expliquer par des nombres insuffisants pour la réinstallation, des ressources inadéquates ou le manque de familiarité avec les besoins spécifiques des personnes âgées. Cet article examine les nombreux besoins qui sont communs à toutes les personnes âgées réfugiées, ainsi que les défis qui les confrontent toutes également, en passant en revue la littérature afférente, et continue en formulant des recommandations pour des interventions et des activités visant à promouvoir l’intégration. Les auteurs soutiennent que l’habileté dans l’évaluation des besoins, alliée à de la créativité dans l’élaboration des programmes, peuvent aider à redonner aux personnes âgées dignité et vitalité, contribuant ainsi à renforcer la cellule familiale. Cet article est basé sur l’expérience amassée par les auteurs au cours de leur travail comme Conseillers techniques au sein de plus de 130 programmes pour les personnes âgées réfugiées aux États Unis pendant la période allant de 1997 à l’an 2000

Faculty Transitions In Online Delivery: Make Or Buy? Tips For Developing A New To You Online Course

In the last few decades, teaching courses online has become a standard practice at many colleges and universities. Although technologies and pedagogies have changed rapidly during this time, developing an online course is still a labor and time-intensive undertaking. With changes in staffing and course offerings, faculty are often faced with determining the most effective and efficient ways to assume responsibilities for online courses. The authors suggest that under particular ownership expectations there are three main approaches for faculty tasked with offering a course online: 1) develop a new course, 2) modify an already existing course, or 3) adopt an existing online course as-is. Some decision guidelines and sample scenarios are offered to aid faculty in determining the best approach for launching or taking ownership of an online course offering

Using CFD as a Rocket Injector Design Tool: Recent Progress at Marshall Space Flight Center

New programs are forcing American propulsion system designers into unfamiliar territory. For instance, industry s answer to the cost and reliability goals set out by the Next Generation Launch Technology Program are engine concepts based on the Oxygen- Rich Staged Combustion Cycle. Historical injector design tools are not well suited for this new task. The empirical correlations do not apply directly to the injector concepts associated with the ORSC cycle. These legacy tools focus primarily on performance with environment evaluation a secondary objective. Additionally, the environmental capability of these tools is usually one-dimensional while the actual environments are at least two- and often three-dimensional. CFD has the potential to calculate performance and multi-dimensional environments but its use in the injector design process has been retarded by long solution turnaround times and insufficient demonstrated accuracy. This paper has documented the parallel paths of program support and technology development currently employed at Marshall Space Flight Center in an effort to move CFD to the forefront of injector design. MSFC has established a long-term goal for use of CFD for combustion devices design. The work on injector design is the heart of that vision and the Combustion Devices CFD Simulation Capability Roadmap that focuses the vision. The SRL concept, combining solution fidelity, robustness and accuracy, has been established as a quantitative gauge of current and desired capability. Three examples of current injector analysis for program support have been presented and discussed. These examples are used to establish the current capability at MSFC for these problems. Shortcomings identified from this experience are being used as inputs to the Roadmap process. The SRL evaluation identified lack of demonstrated solution accuracy as a major issue. Accordingly, the MSFC view of code validation and current MSFC-funded validation efforts were discussed in some detail. The objectives of each effort were noted. Issues relative to code validation for injector design were discussed in some detail. The requirement for CFD support during the design of the experiment was noted and discussed in terms of instrumentation placement and experimental rig uncertainty. In conclusion, MSFC has made significant progress in the last two years in advancing CFD toward the goal of application to injector design. A parallel effort focused on program support and technology development via the SCIT Task have enabled the progress

Using CFD as Rocket Injector Design Tool: Recent Progress at Marshall Space Flight Center

The choice of tools used for injector design is in a transitional phase between exclusive reliance on the empirically based correlations and extensive use of computational fluid dynamics (CFD). The Next Generation Launch Technology (NGLT) Program goals emphasizing lower costs and increased reliability have produced a need to enable CFD as an injector design tool in a shorter time frame. This is the primary objective of the Staged Combustor Injector Technology Task currently under way at Marshall Space Flight Center (MSFC). The documentation of this effort begins with a very brief status of current injector design tools. MSFC's vision for use of CFD as a tool for combustion devices design is stated and discussed with emphasis on the injector. The concept of the Simulation Readiness Level (SRL), comprised of solution fidelity, robustness and accuracy, is introduced and discussed. This quantitative measurement is used to establish the gap between the current state of demonstrated capability and that necessary for regular use in the design process. MSFC's view of the validation process is presented and issues associated with obtaining the necessary data are noted and discussed. Three current experimental efforts aimed at generating validation data are presented. The importance of uncertainty analysis to understand the data quality is also demonstrated. First, a brief status of current injector design tools is provided as context for the current effort. Next, the MSFC vision for using CFD as an injector design tool is stated. A generic CFD-based injector design methodology is also outlined and briefly discussed. Three areas where MSFC is using injector CFD analyses for program support will be discussed. These include the Integrated Powerhead Development (IPD) engine which uses hydrogen and oxygen propellants in a full flow staged combustion (FFSC) cycle and the TR-107 and the RS84 engine both of which use RP-1 and oxygen in an ORSC cycle. Finally, an attempt is made to objectively summarize what progress has been made at MSFC in enabling CFD as an injector design tool

A Multisite Electronic Health Record Integrated Remote Monitoring Intervention for Hypertension Improvement: Protocol for a Randomized Pragmatic Comparative Effectiveness Trial

BackgroundHypertension is a major contributor to various adverse health outcomes. Although previous studies have shown the benefits of home blood pressure (BP) monitoring over office-based measurements, there is limited evidence comparing the effectiveness of whether a BP monitor integrated into the electronic health record is superior to a nonintegrated BP monitor. ObjectiveIn this paper, we describe the protocol for a pragmatic multisite implementation of a quality improvement initiative directly comparing integrated to nonintegrated BP monitors for hypertension improvement. MethodsWe will conduct a randomized, comparative effectiveness trial at 3 large academic health centers across California. The 3 sites will enroll a total of 660 participants (approximately n=220 per site), with 330 in the integrated BP monitor arm and 330 in the nonintegrated BP control arm. The primary outcome of this study will be the absolute difference in systolic BP in mm Hg from enrollment to 6 months. Secondary outcome measures include binary measures of hypertension (controlled vs uncontrolled), hypertension-related health complications, hospitalizations, and death. The list of possible participants will be generated from a central data warehouse. Randomization will occur after enrollment in the study. Participants will use their assigned BP monitor and join site-specific hypertension interventions. Cross-site learning will occur at regular all-site meetings facilitated by the University of California, Los Angeles Value-Based Care Research Consortium. A pre- and poststudy questionnaire will be conducted to further evaluate participants’ perspectives regarding their BP monitor. Linear mixed effects models will be used to compare the primary outcome measure between study arms. Mixed effects logistic regression models will be used to compare secondary outcome measures between study arms. ResultsThe study will start enrolling participants in the second quarter of 2023 and will be completed by the first half of 2024. Results will be published by the end of 2024. ConclusionsThis pragmatic trial will contribute to the growing field of chronic care management using remote monitoring by answering whether a hypertension intervention coupled with an electronic health record integrated home BP monitor improves patients’ hypertension better than a hypertension intervention with a nonintegrated BP monitor. The outcomes of this study may help health system decision makers determine whether to invest in integrated BP monitors for vulnerable patient populations. Trial RegistrationClinicalTrials.gov NCT05390502; clinicaltrials.gov/study/NCT05390502 International Registered Report Identifier (IRRID)PRR1-10.2196/4591

Dissemination of an Enterococcus Inc18-Like vanA Plasmid Associated with Vancomycin-Resistant Staphylococcus aureus▿

Of the 9 vancomycin-resistant Staphylococcus aureus (VRSA) cases reported to date in the literature, 7 occurred in Michigan. In 5 of the 7 Michigan VRSA cases, an Inc18-like vanA plasmid was identified in the VRSA isolate and/or an associated vancomycin-resistant Enterococcus (VRE) isolate from the same patient. This plasmid may play a critical role in the emergence of VRSA. We studied the geographical distribution of the plasmid by testing 1,641 VRE isolates from three separate collections by PCR for plasmid-specific genes traA, repR, and vanA. Isolates from one collection (phase 2) were recovered from surveillance cultures collected in 17 hospitals in 13 states. All VRE isolates from 2 Michigan institutions (n = 386) and between 60 and 70 VRE isolates (n = 883) from the other hospitals were tested. Fifteen VRE isolates (3.9%) from Michigan were positive for an Inc18-like vanA plasmid (9 E. faecalis [12.5%], 3 E. faecium [1.0%], 2 E. avium, and 1 E. raffinosus). Six VRE isolates (0.6%) from outside Michigan were positive (3 E. faecalis [2.7%] and 3 E. faecium [0.4%]). Of all E. faecalis isolates tested, 6.0% were positive for the plasmid, compared to 0.6% for E. faecium and 3.0% for other spp. Fourteen of the 15 plasmid-positive isolates from Michigan had the same Tn1546 insertion site location as the VRSA-associated Inc18-like plasmid, whereas 5 of 6 plasmid-positive isolates from outside Michigan differed in this characteristic. Most plasmid-positive E. faecalis isolates demonstrated diverse patterns by PFGE, with the exception of three pairs with indistinguishable patterns, suggesting that the plasmid is mobile in nature. Although VRE isolates with the VRSA-associated Inc18-like vanA plasmid were more common in Michigan, they remain rare. Periodic surveillance of VRE isolates for the plasmid may be useful in predicting the occurrence of VRSA