Does pre-ordering tests enhance the value of the periodic examination? Study Design - Process implementation with retrospective chart review

<p>Abstract</p> <p>Background</p> <p>To evaluate the value of a pre-ordering process for the pro-active scheduling and completion of appropriate preventive and chronic disease monitoring tests prior to a periodic health examination (PHE).</p> <p>Methods</p> <p>A standardized template was developed and used by our nursing staff to identify and schedule appropriate tests prior to the patients PHE. Chart reviews were completed on all 602 PHE visits for a 3-month interval in a primary care setting. A patient satisfaction survey was administered to a convenience sample of the PHE patients.</p> <p>Results</p> <p>Of all the patients with tests pre-ordered, 87.8% completed the tests. All providers in the division used the process, but some evolved from one template to another over time. Most patients (61%) preferred to get their tests done prior to their PHE appointment. Many of our patients had abnormal test results. With this process, patients were able to benefit from face-to-face discussion of these results directly with their provider.</p> <p>Conclusions</p> <p>A pre-order process was successfully implemented to improve the value of the PHE visit in an internal medicine primary care practice using a standardized approach that allowed for provider autonomy. The process was accepted by patients and providers and resulted in improved office efficiency through reduced message handling. Completion of routine tests before the PHE office visit can help facilitate face-to-face discussions about abnormal results and subsequent management that otherwise may only occur by telephone.</p

Impact of land-use land-cover change on stream water quality in the Reedy Fork- Buffalo Creek watershed, North Carolina: a spatio temporal analysis

The quality of rivers and streams are affected by the land-use-land-cover (LULC) compositions that are present within their watersheds and riparian buffers. Hence, understanding how these LULC compositions, present within watersheds, influences water quality of these water bodies is very important for river management and restoration. This dissertation research was undertaken with the goal of examining the effects changing LULC on stream system. The research was conducted in the Reedy Fork Buffalo Creek watershed in Guilford County, North Carolina to provide a study area of streams within a nested watershed assemblage with a variety of sub-watersheds and varying LULC proportions for comparison. Toward this end, LULC spatial fragmentation of the Reedy Fork Buffalo Creek watershed was quantified for the 2002 through 2013 study period based on remote sensing data. This watershed is located at the headwaters of the Cape Fear River basin, the largest river basin in North Carolina. Analysis of how river flow and several water quality variables were related to landscape attributes at three scales: 100 m, 150 m, and watershed was then performed. The Soil and Water Assessment Tool (SWAT) was used to examine the contribution of LULC to water yield and nitrate loadings in the year 2030 relative to future LULC change scenarios. Results show that the water quality of the Reedy Fork Buffalo Creek changed significantly during the recent decades. These changes in space and time indicate a trend of accelerating deterioration in water quality. Also, LULC pattern had major impacts on the flow and water quality of the Reedy Fork Creek at multiple spatial scales. In particular, impervious LULC, although small in percent cover, exerted a disproportionately large influence both locally and over distance. Results also show that most water quality variables (Conductivity, hardness, nitrate, TKN, and Turbidity) were correlated with landscape pattern on all three spatial scales although the correlation was stronger at the watershed scale than at the buffer scales. Additionally, results from the scenario analysis shows that, compared to the current situation (2010), a 13.5% increase in surface runoff, 9.26% increase in water yield, and 31.85% in increase in nitrate yield was recorded for 2030. These increases were due to the conversion of forest and grass into impervious surfaces. The research highlighted the probable role of the interactions between LULC spatial distribution and water quality. This scale multiplicity suggests that, while water-monitoring and river restoration need to adopt a multi-scale perspective, particular attention should be paid to the watershed scale. In the context of population growth and increasing urban development continuing into the 21st century, preservation and restoration of vegetative LULC and the elimination of impervious surfaces within the watershed should be a primary concern for the general public, the scientific community, and public policy decision makers

Childbirth education : a descriptive investigation

It was the purpose of this study to design and begin the initial phase of the psychological-sociological segment of the Pregnancy Helping System (PHS) as elaborated by the Pregnancy Helping System staff of the Department of Child Development and Family Relations of the School of Home Economics of the University of North Carolina at Greensboro. There were two projected outcomes of this pilot study: a) an evaluation of the research tool designed for use in the PHS, the Parental Decision-Making Questionnaire (PDMQ); and b) a description of the potential for further elaboration and functioning of the PHS. A description of the logistics and utilization of, reaction to, and evaluation of childbirth education services extant in Greensboro, North Carolina, as of June, 1973, were seen as forming the basis of the study. Subjects came from three local obstetrical firms and were chosen on the basis of two critieria: a) they needed to be in their eighth or ninth month of pregnancy; and b) they needed to have completed their childbirth education course if they were enrolled in one. Research forms were distributed in the physicians' offices by their receptionists and were either completed there or completed at home and mailed to the researcher in a stamped, self-addressed envelope provided by a co-researcher. There were 13 subjects in the study group

Distributions of mixed layer properties in North Pacific water mass formation areas: comparison of Argo floats and World Ocean Atlas 2001

ABSTRACT. Winter mixed layer characteristics in the North Pacific Ocean are examined and compared between Argo floats in 2006 and the World Ocean Atlas 2001 (WOA01) climatology for a series of named water masses, North Pacific Tropical Water (NPTW), Eastern Subtropical Mode Water (ESTMW), North Pacific Subtropical Mode Water (NPSTMW), Light Central ModeWater (LCMW) and Dense Central Mode Water (DCMW). The WOA01 is found to be in good agreement with the Argo data in terms of water mass volumes, average temperature-salinity (T-S) properties, and outcrop areas. The exception to this conclusion is for the central mode waters, DCMW and LCMW, whose outcropping is shown to be much more intermittent than is apparent in the WOA01 and whose T-S properties vary from what is shown in theWOA01. Distributions of mixed layer T-S properties measured by floats are examined within the outcropping areas defined by the WOA01 and show some shifting of T-S characteristics within the confines of the named water masses. In 2006, all the water masses were warmer than climatology on average, with a magnitude of about 0.5 degrees C. The NPTW, NPSTMW and LCMW were saltier than climatology and the ESTMW and DCMW fresher, with magnitudes of about 0.05. In order to put these results into context, differences between Argo and WOA01 were examined over the North Pacific between 20 and 45 degrees N. A large-scale warming and freshening is seen throughout this area, except for the western North Pacific, where results were more mixed

Multiscale simulation, data assimilation, and forecasting in support of the SPURS-2 field campaign

A multiscale simulation, data assimilation, forecasting system was developed in support of the SPURS-2 (Salinity Processes in the Upper-ocean Regional Study 2) field campaign. Before the field campaign, a multiyear simulation was produced for characterizing variabilities in upper-ocean salinity, eddy activity, and other parameters and for illustrating major processes that control the region’s upper-ocean salinity at different spatial and temporal scales. This simulation assisted in formulating sampling plans. During the field experiment, the system integrated SPURS-2 measurements with those from routine operational observing networks, including Argo floats and satellite surface temperatures, salinities, and heights, and provided real-time skillful daily forecasts of ocean conditions. Forecast reports were prepared to summarize oceanic conditions and multiscale features and were delivered to the SPURS-2 chief scientist and other SPURS-2 investigators through the SPURS-2 Information System. After the field experiment, the data assimilation system was used to produce a reanalysis product to help quantify contributions of different processes to salinity variability in the region

Patterns of SSS variability in the eastern tropical Pacific: Intraseasonal to interannual timescales from seven years of NASA satellite data

Sea surface salinity (SSS) observations from NASA’s satellite missions, Aquarius/SAC-D and Soil Moisture Active Passive (SMAP), are used to describe spatial patterns of the seasonal cycle, as well as intraseasonal and interannual variability, in the eastern tropical Pacific, the location of the second Salinity Processes in the Upper-ocean Regional Study (SPURS-2) field experiment. The results indicate that the distribution of SSS variance is highly inhomogeneous in both space and time. The seasonal signal is largest in the core of the Eastern Pacific Fresh Pool and in the Gulf of Panama. The interannual signal is highest in a relatively narrow zonal band along approximately 5°N, while the intraseasonal signal appears to be a dominant mode of variability in the zonally stretched near-equatorial region. Located right in the middle of a hotspot of high SSS variance, the SPURS-2 site appears to be at the crossroads of many different processes that shape the distribution of SSS in the eastern tropical Pacific and beyond

The SPURS-2 eastern tropical Pacific field campaign data collection

This paper describes the large, diverse set of in situ data collected during the Salinity Processes in the Upper-ocean Regional Study 2 (SPURS-2) field campaign. The data set includes measurements of the ocean, atmosphere, and fluxes between atmosphere and ocean; measurements of the skin surface layer, bulk mixed layer, and deeper water; (mostly) physical, chemical, and biological measurements; and shipbased, mobile drifting/floating, and moored observations. We include references detailing the methods for collection of each data set, provide DOIs for accessing the data, and note some papers in this special issue that use them. To facilitate broader access to SPURS-2 data and information, we created an online tool that allows users to explore data sets organized by various categories (e.g., instrument type, mobility, depth). This tool will complement content available from the Physical Oceanography Distributed Active Archive Center (PO.DAAC) and will be highly engaging for visual learners

Circadian periodicities of selected social and motor behaviors in two-year-old children : an ethological investigation

The problem investigated in this study was the relationship between the frequencies and durations of selected behavioral categories in a group of two-year-old children and time of day. Specifically, the question asked was, do two-year-olds' behaviors change in a free play setting in a nursery school as a function of time of day? It was hypothesized that there would be no group differences in either frequency or duration of behavior at different times of the day in similar preschool settings. The question was investigated by means of ethological, observational techniques, utilizing videotape technology in the data collection process. The subjects observed were eight two-year-old children concurrently enrolled in a morning nursery school program at Centenary United Methodist Church and an afternoon nursery school program in the Department of Child Development and Family Relations at the University of North Carolina at Greensboro. There were two major time groups, morning and afternoon, and two afternoon time sub-groups, early afternoon (1-2 p. m.) and late afternoon (3-4 p.m.). The subjects were all of the middle socio-economic structure

Physical response of the coastal ocean to Hurricane Isabel near landfall

Abstract. Hurricane Isabel made landfall near Drum Inlet, North Carolina on 18 September 2003. In nearby Onslow Bay an array of 5 moorings captured the response of the coastal ocean to the passage of the storm by measuring currents, surface waves, bottom pressure, temperature and salinity. Temperatures across the continental shelf decreased by 1–3 degrees C, consistent with a surface heat flux estimate of 750W/m2. Salinity decreased at most mooring locations. A calculation at one of the moorings estimates rainfall of 11 cm and a net addition of fresh water at the surface of 8 cm. The low-pass current field shows a shelf-wide movement of water, first to the southwest, with an abrupt reversal to the northeast along the shelf after landfall. Close analysis of this reversal shows it to be a disturbance propagating offshore at a speed somewhat less than the local shallow water wave speed. The high-pass current field at one of the moorings shows a significant increase in kinetic energy at periods between 10 min and 2 h during the approach of the storm. This high-pass flow is isotropic and has a short (&lt;5 m) vertical decorrelation scale. It appears to be closely associated with the winds, Finally we examined the surface wave field at one of the moorings. It shows the swell energy peaking well before the wind waves. At the height of the storm, as the winds rotated rapidly in the cyclonic sense, the wind wave direction rotated as well, with a lag of 45–90 degrees

Evaluating diverse electronic consultation programs with a common framework.

BackgroundElectronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion.MethodsUsing a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems' end-users.ResultsOrganizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies.ConclusionA core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs