2009 Alaska Health Workforce Vacancy Study

Alaska continues to experience health professional shortages. The state has long had a deficient “supply side” characterized by insufficient numbers of key health workers whose recruitment, retention, and training have been impeded by Alaska’s remoteness, harsh climate, rural isolation, low population density, and scarce training resources. Alaska is the only state without a pharmacy school and lacks its own dental and physical therapy schools as well. Health professional shortages can be decreased through the start of new training programs, the expansion of existing programs, and the improvement of the effectiveness of recruitment and retention efforts. However, strategic planning and the execution of such programs require valid and accurate data. To this end, stakeholders such as the Alaska Mental Health Trust Authority (AMHTA) and Alaskan's For Access to Health Care (ACCESS), along with schools and departments within the University of Alaska Anchorage (UAA), funded the Alaska Center for Rural Health-Alaska’s AHEC (ACRH) and the Institute of Social and Economic Research (ISER) to conduct a comprehensive health workforce study during winter and spring of 2009. This report highlights employers’ needs for employees to fill budgeted positions. This is different from a needs assessment that would take into account population demographics and disease incidence and prevalence. This health workforce study is an assessment of health manpower shortage based on budgeted staff positions and their vacancies in organizations throughout the state. Respondents included part-time positions, which resulted in our counting full-time equivalent (FTE) rather than individuals (“bodies”). In situations where a position was divided among more than one occupation (e.g., Dental Assistant and Billing Clerk), we asked the respondent to count the position under which they considered the position’s “primary occupation.” This was a point-in-time cross-sectional study. Recently filled vacancies or imminent vacancies were not counted. Positions filled by relief/temporary/locum/contract health workers were counted as vacancies only if these workers were temporarily filling a currently vacant, budgeted position. Due to budget and time constraints, we were not able to conduct a trend analysis that is a comparison of this study’s findings and the prior 2007 study. The key questions this study sought to answer were (1) How many budgeted positions, either full- or part-time, existed in organizations providing health services in Alaska? (2) How many of these budgeted positions were currently vacant? (3) What was the vacancy rate? (4) How many of the organizations that employ these occupations hired new graduates of training programs? (5) How many of the currently vacant budgeted positions (#2) could be filled by new graduates of training programs? (6) What were the mean and maximum length of time, expressed in months, that the vacancies have existed? (7) What were the principal, underlying causes of vacancies? The study was designed in consultation with an advisory group that included AMHTA, ACCESS, and UAA. The study targeted 93 health occupations. The unit of analysis was the employment site by organization type, which allowed for the allocation of positions and vacancies by geographic region. For each employer, we identified the staff person most knowledgeable about hiring and vacancies. In large organizations this meant that one employer might provide information about multiple sites and organization types; smaller employers were responsible for only a single site.Alaska Mental Health Trust Authority. Alaskan's for Access to Health Care. University of Alaska Fairbanks, Tanana Valley campus Telemedicine program. University of Alaska Anchorage, Community and Technical College. University of Alaska Anchorage, School of Nursing.Acknowledgements / Executive Summary / Table of Contents / Problem and Rationale / Methodology / Limitations of Study / Findings / Appendix A. List of Health Occupations / Appendix B. Health Workforce Surveys / Appendix C. Cover Letter Accompanying Survey Forms / Appendix D. Confidence Intervals for Positions, Vacancies, Number of Vacancies Filled with New Graduates, and Length of Longest Vacancy in Months / Appendix E. Tables of Samples and Estimates of Positions, Vacancies, Vacancy Rates, Number of Vacancies Filled with New Graduates, Mean and Maximum Length of Longest Vacancy in Months / Appendix F. Tables of Occupations Sorted By Estimates of Positions, Vacancies, Vacancy Rates, Number of Vacancies Filled with New Graduates, Mean and Maximum Length of Longest Vacancy in Month

Conotoxin Diversity in Chelyconus ermineus (Born, 1778) and the Convergent Origin of Piscivory in the Atlantic and Indo-Pacific Cones

The transcriptome of the venom duct of the Atlantic piscivorous cone species Chelyconus ermineus (Born, 1778) was determined. The venom repertoire of this species includes at least 378 conotoxin precursors, which could be ascribed to 33 known and 22 new (unassigned) protein superfamilies, respectively.Most abundant superfamilies were T,W, O1, M, O2, and Z, accounting for 57% of all detected diversity. A total of three individuals were sequenced showing considerable intraspecific variation: each individual had many exclusive conotoxin precursors, and only 20% of all inferred mature peptides were common to all individuals. Three different regions (distal, medium, and proximal with respect to the venom bulb) of the venom duct were analyzed independently. Diversity (in terms of number of distinct members) of conotoxin precursor superfamilies increased toward the distal region whereas transcripts detected toward the proximal region showed higher expression levels. Only the superfamilies A and I3 showed statistically significant differential expression across regions of the venom duct. Sequences belonging to the alpha (motor cabal) and kappa (lightning-strike cabal) subfamilies of the superfamily A were mainly detected in the proximal region of the venom duct. The mature peptides of the alpha subfamily had the a4/4 cysteine spacing pattern, which has been shown to selectively target muscle nicotinic-acetylcholine receptors, ultimately producing paralysis. This function is performed by mature peptides having a a3/5 cysteine spacing pattern in piscivorous cone species from the Indo-Pacific region, thereby supporting a convergent evolution of piscivory in cones

History of ESL Pronunciation Teaching

This chapter tells the story of over 150 years in the teaching of English as a second language (ESL) pronunciation. An analysis of historical resources may reveal a reliable history of pronunciation teaching. A consistent theme within the historical record is that prior to the second half of the nineteenth century pronunciation received little attention in L2 classrooms. Beginning in the 1850s and continuing for the next 30 years, early innovators such as Berlitz, Gouin, Marcel, and Predergast were rejecting and transitioning away from classical approaches. A change that resulted in pronunciation teaching\u27s considerably more consequential second wave was the formation in Paris during the period 1886-1889 of the International Phonetic Association. The 1950s-1970s coincide with a slow rise of attention to innovations in how to teach pronunciation. If we may speculate on the future of ESL pronunciation teaching, there is every reason to feel optimistic

Dissecting Novel Grapevine-Mealybug-Virus Interactions

The biological mechanisms underlying vector transmission of grapevine leafroll-associated virus 3 (GLRaV-3) remain poorly understood due to limitations of a technically challenging host- pathogen system in Vitis vinifera. GLRaV-3 was able to infect the model organism Nicotiana benthamiana by insect-vector mediated transmission using the vine mealybug, Planococcus ficus. Working with GLRaV-3 infected N. benthamiana revealed distinct advantages in comparison with its natural host Vitis vinifera, yielding both higher viral protein and virion concentrations in western blot and transmission electron microscopy (TEM) observations, respectively. Immunogold labelling of thin sections through N. benthamiana petioles revealed filamentous particles in the phloem cells of GLRaV-3 positive plants. Comparison of assembled whole genomes from GLRaV-3 infected V. vinifera vs. N. benthamiana revealed identical sequences. High throughput sequencing was used to compare host response to GLRaV-3 infection between V. vinifera and N. benthamiana. General families of differentially expressed genes (DEGs) common in both hosts followed similar expression changes with six upregulated, seven downregulated, and two stably expressed genes in common. Overall, both hosts have many DEGs unique to each host as well as responses in common to GLRaV-3 infection. The vine mealybug, Planococcus ficus, fed through a membrane feeding system on GLRaV-3 viral purifications from both V. vinifera and N. benthamiana, and transmitted the virus to test plants.An immunofluorescence approach was used to localize virions to two retention sites in P. ficus mouthparts. Assays testing molecules capable of blocking virus transmission demonstrated that GLRaV-3 transmission by P. ficus can be disrupted. Our results indicate that our membrane feeding system and transmission blocking assays are a valid approach and can be used to screen other candidate blocking molecules. GLRaV-3 continues to impact grape-growing regions worldwide and the lack of knowledge surrounding virus-vector interactions remains limiting to the field. Elucidating the transmission biology of this important virus contributes to the eventual goal of blocking of transmission in insect vectors and the development of improved control strategies in vineyards

Dissecting Novel Grapevine-Mealybug-Virus Interactions

The biological mechanisms underlying vector transmission of grapevine leafroll-associated virus 3 (GLRaV-3) remain poorly understood due to limitations of a technically challenging host- pathogen system in Vitis vinifera. GLRaV-3 was able to infect the model organism Nicotiana benthamiana by insect-vector mediated transmission using the vine mealybug, Planococcus ficus. Working with GLRaV-3 infected N. benthamiana revealed distinct advantages in comparison with its natural host Vitis vinifera, yielding both higher viral protein and virion concentrations in western blot and transmission electron microscopy (TEM) observations, respectively. Immunogold labelling of thin sections through N. benthamiana petioles revealed filamentous particles in the phloem cells of GLRaV-3 positive plants. Comparison of assembled whole genomes from GLRaV-3 infected V. vinifera vs. N. benthamiana revealed identical sequences. High throughput sequencing was used to compare host response to GLRaV-3 infection between V. vinifera and N. benthamiana. General families of differentially expressed genes (DEGs) common in both hosts followed similar expression changes with six upregulated, seven downregulated, and two stably expressed genes in common. Overall, both hosts have many DEGs unique to each host as well as responses in common to GLRaV-3 infection. The vine mealybug, Planococcus ficus, fed through a membrane feeding system on GLRaV-3 viral purifications from both V. vinifera and N. benthamiana, and transmitted the virus to test plants.An immunofluorescence approach was used to localize virions to two retention sites in P. ficus mouthparts. Assays testing molecules capable of blocking virus transmission demonstrated that GLRaV-3 transmission by P. ficus can be disrupted. Our results indicate that our membrane feeding system and transmission blocking assays are a valid approach and can be used to screen other candidate blocking molecules. GLRaV-3 continues to impact grape-growing regions worldwide and the lack of knowledge surrounding virus-vector interactions remains limiting to the field. Elucidating the transmission biology of this important virus contributes to the eventual goal of blocking of transmission in insect vectors and the development of improved control strategies in vineyards