Cluster randomized trial comparing standard versus enhanced implementation strategies for improving outreach to persons with SMI: 12-month results

http://deepblue.lib.umich.edu/bitstream/2027.42/134545/1/13012_2015_Article_940.pd

Cluster randomized adaptive implementation trial comparing a standard versus enhanced implementation intervention to improve uptake of an effective re-engagement program for patients with serious mental illness

Abstract Background Persons with serious mental illness (SMI) are disproportionately burdened by premature mortality. This disparity is exacerbated by poor continuity of care with the health system. The Veterans Health Administration (VA) developed Re-Engage, an effective population-based outreach program to identify veterans with SMI lost to care and to reconnect them with VA services. However, such programs often encounter barriers getting implemented into routine care. Adaptive designs are needed when the implementation intervention requires augmentation within sites that do not initially respond to an initial implementation intervention. This protocol describes the methods used in an adaptive implementation design study that aims to compare the effectiveness of a standard implementation strategy (Replicating Effective Programs, or REP) with REP enhanced with External Facilitation (enhanced REP) to promote the uptake of Re-Engage. Methods/Design This study employs a four-phase, two-arm, longitudinal, clustered randomized trial design. VA sites (n = 158) across the United States with a designated Re-Engage provider, at least one Veteran with SMI lost to care, and who received standard REP during a six-month run-in phase. Subsequently, 88 sites with inadequate uptake were stratified at the cluster level by geographic region (n = 4) and VA regional service network (n = 20) and randomized to REP (n = 49) vs. enhanced REP (n = 39) in phase two. The primary outcome was the percentage of veterans on each facility outreach list documented on an electronic web registry. The intervention was at the site and network level and consisted of standard REP versus REP enhanced by external phone facilitation consults. At 12 months, enhanced REP sites returned to standard REP and 36 sites with inadequate participation received enhanced REP for six months in phase three. Secondary implementation outcomes included the percentage of veterans contacted directly by site providers and the percentage re-engaged in VA health services. Discussion Adaptive implementation designs consisting of a sequence of decision rules that are tailored based on a site’s uptake of an effective program may produce more relevant, rapid, and generalizable results by more quickly validating or rejecting new implementation strategies, thus enhancing the efficiency and sustainability of implementation research and potentially leading to the rollout of more cost-efficient implementation strategies. Trial registration Current Controlled Trials ISRCTN21059161 .http://deepblue.lib.umich.edu/bitstream/2027.42/112609/1/13012_2013_Article_711.pd

Accelerator experiments with soft protons and hyper-velocity dust particles: application to ongoing projects of future X-ray missions

We report on our activities, currently in progress, aimed at performing accelerator experiments with soft protons and hyper-velocity dust particles. They include tests of different types of X-ray detectors and related components (such as filters) and measurements of scattering of soft protons and hyper-velocity dust particles off X-ray mirror shells. These activities have been identified as a goal in the context of a number of ongoing space projects in order to assess the risk posed by environmental radiation and dust and qualify the adopted instrumentation with respect to possible damage or performance degradation. In this paper we focus on tests for the Silicon Drift Detectors (SDDs) used aboard the LOFT space mission. We use the Van de Graaff accelerators at the University of T\"ubingen and at the Max Planck Institute for Nuclear Physics (MPIK) in Heidelberg, for soft proton and hyper-velocity dust tests respectively. We present the experimental set-up adopted to perform the tests, status of the activities and some very preliminary results achieved at present time.Comment: Proceedings of SPIE, Vol. 8443, Paper No. 8443-24, 201

Organizational factors and depression management in community-based primary care settings

Abstract Background Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework. Methods We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT) infrastructure, and external incentives) and process features (e.g., staff performance, degree of integrated depression care, and IT performance). Results The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment. Conclusions The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition, survey information can inform efforts of individual primary care practices in customizing intervention strategies to improve depression management.http://deepblue.lib.umich.edu/bitstream/2027.42/78269/1/1748-5908-4-84.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78269/2/1748-5908-4-84-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78269/3/1748-5908-4-84.pdfPeer Reviewe

Sea-Level Rise: Projections for Maryland 2018

In fulfillment of requirements of the Maryland Commission on Climate Change Act of 2015, this report provides updated projections of the amount of sea-level rise relative to Maryland coastal lands that is expected into the next century. These projections represent the consensus of an Expert Group drawn from the Mid-Atlantic region. The framework for these projections is explicitly tied to the projections of global sea-level rise included in the Intergovernmental Panel on Climate Change Fifth Assessment (2014) and incorporates regional factors such as subsidence, distance from melting glaciers and polar ice sheets, and ocean currents. The probability distribution of estimates of relative sea-level rise from the baseline year of 2000 are provided over time and, after 2050, for three different greenhouse gas emissions pathways: Growing Emissions (RCP8.5), Stabilized Emissions (RCP4.5), and meeting the Paris Agreement (RCP2.6). This framework has been recently used in developing relative sea-level rise projections for California, Oregon, Washington, New Jersey, and Delaware as well as several metropolitan areas. The Likely range (66% probability) of the relative rise of mean sea level expected in Maryland between 2000 and 2050 is 0.8 to 1.6 feet, with about a one-in-twenty chance it could exceed 2.0 feet and about a one-in-one hundred chance it could exceed 2.3 feet. Later this century, rates of sea-level rise increasingly depend on the future pathway of global emissions of greenhouse gases during the next sixty years. If emissions continue to grow well into the second half of the 21st century, the Likely range of sea-level rise experienced in Maryland is 2.0 to 4.2 feet over this century, two to four times the sea-level rise experienced during the 20th century. Moreover, there is a one-in-twenty chance that it could exceed 5.2 feet. If, on the other hand, global society were able to bring net greenhouse gas emissions to zero in time to meet the goals of the Paris Climate Agreement and reduce emissions sufficient to limit the increase in global mean temperature to less than 2Celsius over pre-industrial levels, the Likely range for 2100 is 1.2 to 3.0 feet, with a one-in-twenty chance that it would exceed 3.7 feet. The difference in sea-level rise between these contrasting scenarios would diverge even more during the next century, with the failure to reduce emissions in the near term resulting in much greater sea-level rise 100 years from now. Moreover, recent research suggests that, without imminent and substantial reductions in greenhouse gas emissions, the loss of polar ice sheets-and thus the rate of sea-level rise-may be more rapid than assumed in these projections, particularly under the Growing Emissions scenario. These probabilistic sea-level rise projections can and should be used in planning and regulation, infrastructure siting and design, estimation of changes in tidal range and storm surge, developing inundation mapping tools, and adaptation strategies for high-tide flooding and saltwater intrusion

The Economics of Integrated Depression Care: The University of Michigan Study

A goal of the Robert Wood Johnson Depression and Primary Care Initiative at the University of Michigan is to create and implement the clinical care and financial systems necessary to enable links between primary care and mental health specialty depression care. This paper describes the economic issues related to resources required, the mechanisms to distribute those resources, and the support that must be garnered from stakeholders. By systematic measurement and application, we assess the cost, price and selected consequences of these efforts. The study illustrates the need for both centralized and distributed capacity and support for innovative models of care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44096/1/10488_2005_Article_4231.pd

Flocculation of influenza virus by specific anti-neuraminidase antibody

1. Flocculation of purified preparations of influenza virus has been demonstrated to occur in the presence of low dilutions of specific anti-neuraminidase sera. High dilutions of the sera caused microscopic aggregation of virions. It is suggested that the effects of anti-neuraminidase antibody on the replication of influenza virus observed in vitro could be caused by antibody binding virions to infected cells, rather than by inhibition of neuraminidase enzymic activity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41680/1/705_2005_Article_BF01253756.pd

Gamer Girls: Navigating a Subculture of Gender Inequality

Purpose Video gaming, which remains culturally embedded in masculine ideals, is increasingly becoming a leisure activity for female consumers. Guided by social dominance theory, this paper examines how female gamers navigate the masculine-oriented gaming consumption context. Methodology/approach Eight avid female gamers (ages 20–29) participated in-depth interviews, following a phenomenological approach to better understand their lived experiences with video gaming. Data were analyzed using phenomenological procedures. Findings Findings reveal an undercurrent of gender-based consumer vulnerability, driven by stereotypical perceptions of “gamer girls” in the masculine-oriented gaming subculture. Further, the findings highlight the multilayered, multidimensional nature of gaming as a vulnerable consumption environment, at individual, marketplace, and cultural levels. Social implications The culturally embedded gamer girl stereotype provides a foundation upon which characteristics of consumer vulnerability flourish, including a culture of gender-based consumer harassment, systematic disempowerment in the marketplace, and conflicting actions and attitudes toward future cultural change. Originality/value This research suggests female gamers struggle to gain a foothold in gaming due to the socially and culturally constructed masculine dominance of the field. Our research study provides a stepping-stone for future scholars to explore gendered subcultures and begins to address the dynamic interplay of power, gender, technology, and the market