A Survey and Analysis of Educational Materials Addressing the Health Consequences of Drinking Nitrate Contaminated Water in Medical Clinics Located in the Most At-Risk Areas of Nebraska: Are Healthcare Providers Equipped to Protect and Educate Their Patients?

Background: Eighty five percent of Nebraskans rely heavily on groundwater sources, including private wells, as their primary source of drinking water. Nitrate is one of the most common chemicals found in private well water. Numerous studies demonstrated the serious human health consequences from prolonged nitrate exposure. Therefore, due to the potential health risks, this project aimed to identify and evaluate the existing knowledge and awareness among healthcare providers as well as the educational materials in medical clinics in Nebraska related to health effects of drinking nitrate contaminated water. Methods: An 8 multiple choice question survey was developed using Microsoft Forms. The survey was disseminated to healthcare providers in medical clinics located in several counties of Nebraska with high nitrate contaminated waters. Respondents completed the survey electronically through a unique weblink as well as in-person meetings. All responses were stored in the Microsoft Forms database. Later, analytical functions were used to perform quantitative analysis. Results and Findings: Four key findings resulted from the survey and its analysis. 1. The majority of health care providers (63%) have had no to very little formal education or training on the adverse health consequences of drinking nitrate contaminated water. 2. Currently, many providers (63%) do not have access to any educational materials regarding adverse health consequences of drinking nitrate contaminated water. 3. The top educational materials health care providers requested to educate themselves were educational videos and continuing education credits. 4. The top educational materials health care providers requested to educate their patients were brochures, flyers, and posters. Conclusion: Many health care providers have no-to-little formal training or education on the adverse health consequences of drinking nitrate contaminated water. Additionally, providers reported not having access to educational materials regarding the health consequences of drinking nitrate contaminated water. Based on our assessment, educational materials for clinics are needed in the locations surveyed. To increase education and awareness, we suggest offering health care providers educational videos and continuing education credits on hazards and dangers of nitrate in drinking water. To help providers better educate their patients, we suggest the development of brochures, flyers and posters on health concerns of nitrate in drinking water. Because of limitations in the sample size, we recommended expanding the survey to include more questions and surveying medical clinics across the entire state to draw more representative conclusions. By evaluating the needs of health care workers on water quality related health issues, we can help with future education and outreach efforts to reduce health impacts associated with consuming nitrate contaminated water

Causal inference in multilevel designs

The general theory of causal effects (Steyer et al., 2009) is used to develop a theory of causal inference for multilevel designs - i.e., for designs in which the effects of treatments are evaluated on units nested within clusters - that extends and consolidates previous approaches. Two multilevel causality spaces for different classes of multilevel designs are used to define true-effect variables, average causal effects, conditional causal effects and prima-facie effects. Unbiasedness, as the weakest condition under which average and conditional causal effects are identified, and its sufficient conditions are outlined. Next, stability assumptions for causal inference in multilevel designs are discussed in relation to the general theory of causal effects and a taxonomy of multilevel designs is introduced. Building upon this theoretical framework, the generalized analysis of covariance (ANCOVA), that extends the conventional multilevel ANCOVA by identifying the average causal effect in the presence of interactions, is developed for non-randomized multilevel designs with treatment assignment at unit- and at the cluster-level. Two simulation studies tested several statistical implementations of the generalized ANCOVAs. The results showed that contextual effects have to be taken into account in the specification of adjustment models, that predictors have to be modeled as stochastic to obtain correct standard errors of the average causal effects and that the unreliability of the empirical cluster means has to be accounted for in designs with treatment assignment at the cluster-level. The statistical methods studied in the simulations were applied to two empirical examples from educational research to demonstrate the implementations in practice. Finally, the scope of the general theory of causal effects, the advantages and disadvantages of the generalized ANCOVA and alternative adjustment methods are discussed and an overview of further research needs is given

Kundenbindung in Handels- und Serviceunternehmen - Die Wirkung von Kundenbindungsinstrumenten auf Einstellungen und Kaufverhalten

Zusammenfassung: Um sich vom Wettbewerb zu differenzieren, setzen Marketingmanager unterschiedliche Kundenbindungsinstrumente ein. Gerade im Rahmen von Loyalitätsprogrammen bieten sich für Handels- und Serviceunternehmen heute vielfältige Möglichkeiten zur individuellen Kundenansprache. Die damit einhergehenden Investitionen sind allerdings nicht immer von Erfolg gekrönt, wie der Literaturüberblick zeigt. Dies liegt vor allem daran, dass Marketingentscheider unterschiedliche Wirkungsweisen bestimmter Instrumente zu wenig berücksichtigen. Der Einsatz erfolgt oft willkürlich und die Instrumente sind zu wenig auf die jeweiligen Bedingungen und die entsprechenden Zielgruppen abgestimmt. Vor diesem Hintergrund gibt der Beitrag einen Überblick zum Thema "Kundenbindungsinstrumente". Er zeigt eine umfassende Klassifizierung auf und begründet die Wirkungsweise unterschiedlicher Kundenbindungsinstrumente aus motivationstheoretischer Sicht. Auf Basis empirischer Erkenntnisse beschreibt er die Wirkung von Kundenbindungsinstrumenten unter verschiedenen Bedingungen und leitet schliesslich Implikationen für das Management zum effektiven und effizienten Einsatz von Kundenbindungsinstrumenten ab. Abschliessend werden offene Forschungsfelder in diesem Bereich diskutier

Risk-Sensitivity in Sensorimotor Control

Recent advances in theoretical neuroscience suggest that motor control can be considered as a continuous decision-making process in which uncertainty plays a key role. Decision-makers can be risk-sensitive with respect to this uncertainty in that they may not only consider the average payoff of an outcome, but also consider the variability of the payoffs. Although such risk-sensitivity is a well-established phenomenon in psychology and economics, it has been much less studied in motor control. In fact, leading theories of motor control, such as optimal feedback control, assume that motor behaviors can be explained as the optimization of a given expected payoff or cost. Here we review evidence that humans exhibit risk-sensitivity in their motor behaviors, thereby demonstrating sensitivity to the variability of “motor costs.” Furthermore, we discuss how risk-sensitivity can be incorporated into optimal feedback control models of motor control. We conclude that risk-sensitivity is an important concept in understanding individual motor behavior under uncertainty

The effect of bank shocks on firm-level and aggregate investment

We show that credit supply shocks have a strong impact on firm-level as well as aggregate investment by applying the methodology developed by Amiti and Weinstein (2013) to a rich dataset of matched bank-firm loans in the Portuguese economy for the period 2005 to 2013. We argue that their decomposition framework can also be used in the presence of small firms with only one banking relationship as long as they account for only a small share of the total loan volume of their banks. The growth rate of individual loans in our dataset is decomposed into bank, firm, industry and common shocks. Adverse bank shocks are found to impair firm-level investment in all firms in our sample, but in particular for small firms and those with no access to alternative financing sources. For the economy as a whole, granular shocks in the banking system account for around 20-40% of aggregate investment dynamics

Mini-High Temperature HEPA Filter Test Unit

There is a need for better HEPA filter materials, especially those able to withstand higher temperatures as experienced in fire conditions. In order to test these materials our team built a Mini High Temperature Testing Unit (MHTTU) that can rapidly, efficiently, and inexpensively test a large number of new and innovative materials for HEPA filter components. MHTTU test results will be used to down select the most promising materials for HEPA filter components (e.g., media, sealants, gaskets) for full scale testing in the HTTU. There are already some pieces of equipment that exist in other parts of the country that produce similar effects, but do not fulfil our specific needs of 1300°F air at the low flow rates of 1.25-12 ACFM. Our attempts to source heaters were iterative due to the difficult nature of finding items that fulfilled both extreme specifications. The design decided upon pre-testing involved using two individually operating heaters, one for each end of flow regime. After initial testing, the immersion heater, originally intended solely for the low range of flows proved better able to handle our complete range than the higher flow heat torch. With the current design, we were only able to reach a temperature of 1116F, but we were able to meet all of our other specifications, including flow rates, warm up time, and differential pressure drop across the test section. We believe that the majority of our heat loss was shed through the uninsulated housing of the heat torch, and recommend removing the heat torch and transfer section from the device. This would lessen the mass of stainless steel to be heated as well as remove a relatively large heat shedding fin from the device