Identifying characteristics of mentally ill homeless individuals who are successfully linked to health and social services post-incarceration via the jail inreach project

Healthcare for the Homeless—Houston (HHH) received a research grant from The Medallion Foundation, Inc. in March 2006 to pilot The Jail Inreach Project, an intensive “inreach” initiative to assess the impact of providing continuity of mental and primary health care services for homeless individuals who suffer from mental illness and/or substance abuse being released from jail. This pilot project was initiated by HHH, in collaboration with the Harris County Sheriff’s Office and the Mental Health Mental Retardation Authority of Harris County (MHMRA). Those who are flagged as “frequent flyers” and who are diagnosed with a mental illness are referred to the Jail Inreach Project. In order to maximize the effectiveness of the discharge plan, case managers offer the option of meeting the client at the time of release and bring them to the HHH clinic located four blocks from the jail. Participation in both the program and the option for direct release to the care of a case manager are voluntary.^ The purpose of this study is to determine the outcomes of the Jail Inreach Project and addresses the following objectives: (1) to evaluate the characteristics of inmates that chose to be released from jail to the direct care of an HHH case manager versus those who opt for self release and (2) to determine the number and percent of inmates that are linked to services and relationship with type of release (direct versus indirect), (3) to determine if there is a relationship between outcomes and characteristics and (4) to determine what outcomes are a function of release, controlling for characteristics. Statistical analysis, including frequencies, cross tabulations, chi-square and logistical regression, found that those who opt for self release are six times less likely to be successfully linked to services and that gender is the most significant predictor of choosing self release. Men are far more likely to opt for self release than women engaged in this program. These findings help inform policy and program design and development that addresses the difference in service utilization and successful linkage to services post-incarceration. Successful linkage to services, thus continuity of and access to care, further impact the effects of the revolving door phenomenon of mentally ill homeless individuals cycling between the streets, jails and hospital emergency centers.^

A study of the relationship of support systems and adolescent pregnancy outcomes in an adolescent family life project

This study analyzed the relationship of family support systems and adolescent pregnancy outcomes. The population for the study was 390 adolescents who had attended the Marion County Health Department Adolescent Family Life Project in Indianapolis, Indiana during a two-year period.^ The study is unique in that it afforded the opportunity to compare adolescent pregnancy-related characteristics, of white and non-white adolescents in the same study.^ The pregnancy outcomes studied were: Infant birthweight, school attendance, and pregnancy recidivism.^ Significant results were found in the analysis that supported other research in regard to factors that are associated with school attendance when family support, adolescent's age, and ethnicity were controlled. Infant birthweight and repeat pregnancy outcome relationships were not found to have any consistently significant relationship with independent variables anticipated to be associated. However, the comparisons of infant birthweight among the adolescents with, and without, family support, by ethnicity resulted in some interesting findings. Repeat pregnancy proved an enigma, in that there seemed to be almost no variables in this study that were associated with the adolescent having a repeat pregnancy.^ Familial support in this study seemed to be of less importance as a factor in adolescent pregnancy outcomes than was ethnicity. The non-white adolescents in this study had a better record for remaining in school, both those non-white adolescents who lived with parents, and those who did not live with parents. More low birthweight occurred in the non-white adolescent, both those adolescents who lived with parents, and those who did not live with parents. Repeat pregnancy occurred more in the non-white adolescent whether she lived with parents, or did not live with parents. ^

Thrombolytic therapy for acute myocardial infarction: A cohort study to evaluate a selective approach to invasive diagnosis and therapy. The Corpus Christi Heart Project

Coronary perfusion with thrombolytic therapy and selective reperfusion by percutaneous transluminal coronary angioplasty (PTCA) were examined in the Corpus Christi Heart Project, a population-based surveillance program for hospitalized acute myocardial infarction (MI) patients in a biethnic community of Mexican-Americans (MAs) and non-Hispanic whites (NHWs). Results were based on 250 (12.4%) patients who received thromobolytic therapy in a cohort of 2011 acute MI cases. Out of these 107 (42.8%) underwent PTCA with a mean follow-up of 25 months. There were 186 (74.4%) men and 64 (25.6%) women; 148 (59.2%) were NHWs, 86 (34.4%) were MAs. Thrombolysis and PTCA were performed less frequently in women than in men, and less frequently in MAs than in NHWs.^ According to the coronary reperfusion interventions used, patients were divided in two groups, those that received no-PTCA (57.2%) and the other that underwent PTCA (42.8%) after thrombolysis. The case-fatality rate was higher in no-PTCA patients than in the PTCA (7.7% versus 5.6%), as was mortality at one year (16.2% versus 10.5%). Reperfusion was successful in 48.0% in the entire cohort and (51.4% versus 45.6%) in the PTCA and no-PTCA groups. Mortality in the successful reperfusion patients was 5.0% compared to 22.3% in the unsuccessful reperfusion group (p = 0.00016, 95% CI: 1.98-11.6).^ Cardiac catheterization was performed in 86.4% thrombolytic patients. Severe stenosis ($>$75%) obstruction was present most commonly in the left descending artery (52.8%) and in the right coronary artery (52.8%). The occurrence of adverse in-hospital clinical events was higher in the no-PTCA as compared to the PTCA and catheterized patients with the exception of reperfusion arrythmias (p = 0.140; Fisher's exact test p = 0.129).^ Cox regression analysis was used to study the relationship between selected variables and mortality. Apart from successful reperfusion, age group (p = 0.028, 95% CI: 2.1-12.42), site of acute MI index (p = 0.050) and ejection-fraction (p = 0.052) were predictors of long-term survival. The ejection-fraction in the PTCA group was higher than (median 78% versus 53%) in the no-PTCA group. Assessed by logistic regression analysis history of high cholesterol ($>$200mg/dl) and diabetes mellites did have significant prognostic value (p = 0.0233; p = 0.0318) in long-term survival irrespective of treatment status.^ In conclusion, the results of this study support the idea that the use of PTCA as a selective intervention following thrombolysis improves survival of patients with acute MI. The use of PTCA in this setting appears to be safe. However, we can not exclude the possibility that some of these results may have occurred due to the exclusion from PTCA of high risk patients (selection bias). ^

COSTS AND EFFECTS OF ARKANSAS' LONG-TERM CARE DEMONSTRATION PROJECT (MEDICAID, CHANELLING, COMMUNITY ASSESSMENT)

The purpose of this study was to assess the impact of the Arkansas Long-Term Care Demonstration Project upon Arkansas' Medicaid expenditures and upon the clients it serves. A Retrospective Medicaid expenditure study component used analyses of variance techniques to test for the Project's effects upon aggregated expenditures for 28 demonstration and control counties representing 25 percent of the State's population over four years, 1979-1982.^ A second approach to the study question utilized a 1982 prospective sample of 458 demonstration and control clients from the same 28 counties. The disability level or need for care of each patient was established a priori. The extent to which an individual's variation in Medicaid utilization and costs was explained by patient need, presence or absence of the channeling project's placement decision or some other patient characteristic was examined by multiple regression analysis. Long-term and acute care Medicaid, Medicare, third party, self-pay and the grand total of all Medicaid claims were analyzed for project effects and explanatory relationships.^ The main project effect was to increase personal care costs without reducing nursing home or acute care costs (Prospective Study). Expansion of clients appeared to occur in personal care (Prospective Study) and minimum care nursing home (Retrospective Study) for the project areas. Cost-shifting between Medicaid and Medicare in the project areas and two different patterns of utilization in the North and South projects tended to offset each other such that no differences in total costs between the project areas and demonstration areas occurred. The project was significant ((beta) = .22, p < .001) only for personal care costs. The explanatory power of this personal care regression model (R('2) = .36) was comparable to other reported health services utilization models. Other variables (Medicare buy-in, level of disability, Social Security Supplemental Income (SSI), net monthly income, North/South areas and age) explained more variation in the other twelve cost regression models. ^

Adherence to HIV /AIDS therapies among low -literacy populations: The ALP project

Adherence to HIV/AIDS therapies has been an important health problem since the early 1980s when AZT was first prescribed as a therapy for HIV/AIDS. It became particularly important between 1995 and 1997 with the advent of protease inhibitors (Chesney, Ickovics, Hecht, Sikipa, & Rabkin J., 1999) and became even more significant as persons with HIV/AIDS began to develop resistance to medications. Low-literacy populations have poorer health (Brez & Taylor, 1997) and higher AIDS rates (Simon, Hu, Diaz, & Kerndt, 1995), than their higher literacy counterparts due to delayed treatment (Baker, Parker, Williams, Clark, & Nurss, 1997), shame of literacy skills (Parikh, 1996), and poor access to care (Williams, et al., 1995). Poorer health and higher AIDS rates can also be attributed to poor patient-provider relationships (Crespo-Fierro, 1997; Eldred, Wu, Chaisson, & Moore, 1998) to a poorer understanding of medical protocols (Murphy, 1997), and inadequate patient education (Ungvarski, 1997; Davis, Michielutte, Askov, Williams, & Weiss, 1998, Doak, Doak, & Root, 1996). ^ The ALP intervention was developed for HIV positive low-literacy populations of African American women in Houston, Texas. The intervention was based on a needs assessment, using the PRECEDE model, an innovative process referred to as Intervention Mapping, and validated using formative evaluation methods with 54 individuals. The needs assessment resulted in a list of behavioral, environmental, predisposing, enabling, and reinforcing determinants of adherence. The Intervention Mapping framework was used to refine these determinants and develop a list of objectives describing what must be learned or changed to for the target population to adhere to HIV/AIDS therapies. Methods and strategies, were developed using theoretical constructs from the Health Belief Model (Rosenstock, 1974) and Social Cognitive Theory (Bandura, 1986). These theories, empirical evidence, and information from the target population indicated that perceived susceptibility, perceived severity, outcome expectations, and self-efficacy were important and changeable determinants of adherence to HIV/AIDS therapies for this population. ^ These components were brought together in the form of a theory-based color cartoon book and 10-minute cassette tape. The book was developed for people with 2.9 years of U.S. education as measured with the Flesch-Kincaid Grade Level method and the script was recorded onto a cassette tape to make it suitable for populations with even lower-literacy skills. A formative evaluation was conducted to ensure that the content and structure were accurate, clear, realistic, readable, appropriate, and likely to be used as intended. ^

Hydrology dataset based on 111 CTD stations in the North Aegean Sea during June 1998 from the project INTERREGAEGEAN

The combination of two research projects offered us the opportunity to perform a comprehensive study of the seasonal evolution of the hydrological structure and the circulation of the North Aegean Sea, at the northern extremes of the eastern Mediterranean. The combination of brackish water inflow from the Dardanelles and the sea-bottom relief dictate the significant differences between the North and South Aegean water columns. The relatively warm and highly saline South Aegean waters enter the North Aegean through the dominant cyclonic circulation of the basin. In the North Aegean, three layers of distinct water masses of very different properties are observed: The 20-50 m thick surface layer is occupied mainly by Black Sea Water, modified on its way through the Bosphorus, the Sea of Marmara and the Dardanelles. Below the surface layer there is warm and highly saline water originating in the South Aegean and the Levantine, extending down to 350-400 m depth. Below this layer, the deeper-than-400 m basins of the North Aegean contain locally formed, very dense water with different i/S characteristics at each subbasin. The circulation is characterised by a series of permanent, semi-permanent and transient mesoscale features, overlaid on the general slow cyclonic circulation of the Aegean. The mesoscale activity, while not necessarily important in enhancing isopycnal mixing in the region, in combination with the very high stratification of the upper layers, however, increases the residence time of the water of the upper layers in the general area of the North Aegean. As a result, water having out-flowed from the Black Sea in the winter, forms a separate distinct layer in the region in spring (lying between "younger" BSW and the Levantine origin water), and is still traceable in the water column in late summer.

Pb isotopes in individual sand-sized (>150 µm) ice-rafted feldspars deposited at subpolar North Atlantic Ocean Deep Sea Drilling Project Site 611 during the late Pliocene (Marine Isotope Stages, MIS, G6 through 100)

The onset of abundant ice-rafted debris (IRD) deposition in the Nordic Seas and subpolar North Atlantic Ocean 2.72 millions of years ago (Ma) is thought to record the Pliocene onset of major northern hemisphere glaciation (NHG) due to a synchronous advance of North American Laurentide, Scandinavian and Greenland ice-sheets to their marine calving margins during marine isotope stage (MIS) G6. Numerous marine and terrestrial records from the Nordic Seas region indicate that extensive ice sheets on Greenland and Scandinavia increased IRD inputs to these seas from 2.72 Ma. The timing of ice-sheet expansion on North America as tracked by IRD deposition in the subpolar North Atlantic Ocean, however, is less clear because both Europe and North America are potential sources for icebergs in this region. Moreover, cosmogenic-dating of terrestrial tills on North America indicate that the Laurentide Ice Sheet did not extend to ~39°N until 2.4 ±0.14 Ma, at least 180 ka after the onset of major IRD deposition at 2.72 Ma. To address this problem,we present the first detailed analysis of the geochemical provenance of individual sand-sized IRD deposited in the subpolar North Atlantic Ocean between MIS G6 and 100 (~2.72-2.52 Ma). IRD provenance is assessed using laser ablation lead (Pb) isotope analyses of single ice-rafted (>150 mm) feldspar grains. To track when an ice-rafting setting consistent with major NHG first occurred in the North Atlantic Ocean during the Pliocene intensification of NHG (iNHG), we investigate when the Pb-isotope composition (206Pb/204Pb, 207Pb/204Pb, 208Pb/204Pb) of feldspars deposited at DSDP Site 611 first resembles that determined for IRD deposited at this site during MIS 100, the oldest glacial for which there exists convincing evidence for widespread glaciation of North America. Whilst Quaternary-magnitude IRD fluxes exist at Site 611 during glacials from 2.72 Ma, we find that the provenance of this IRD is not constant. Instead, we find that the Pb isotope composition of IRD at our study site is not consistent with major NHG until MIS G2 (2.64 Ma). We hypothesise that IRD deposition in the North Atlantic Ocean prior to MIS G2 was dominated by iceberg calving from Greenland and Scandinavia. We further suggest that the grounding line of continental ice on Northeast America may not have extended onto the continental shelf and calved significant numbers of icebergs to the North Atlantic Ocean during glacials until 2.64 Ma.

Project-based learning experience on Data Structures course

This paper presents the innovations in the practical work of the Data Structures subject carried out in the last five years, including a transition period and a first year of implantation of the European Higher Education Area. The practical coursework is inspired by a project-based methodology and from 2008/2009 additional laboratory sessions are included in the subject schedule. We will present the academic results and ratios of the mentioned time period which imply a significant improvement on students' performance.

Final year project: students and instructors perceptions as a competence-strengthening tool for engineering students

This work indicates the importance of the Final Year Project (FYP) in the strengthening of competences of engineering students. The study also shows which personal competences of students are reinforced most during the FYP process,including the preparation, elaboration, presentation and defence stages. In order to gather information on this subject, a survey was conducted at two different Spanish technical universities—one public and one private—and a comparative analysis was performed of the questionnaires collected. The competence model considered is that used by the Accreditation Board for Engineering and Technology (ABET), since the official title of the public university has been accredited by this model. The results indicate which personal and professional competences of students are reinforced well by undertaking the FYP. Any significant differences in response by university are explained in the study. For validation purposes, the results were contrasted with the instructor’s perspective using the triangulation methodology. Finally, the conclusions drawn will permit the design of new study plans to cope more effectively with the challenges of the FYP in the new Bologna framework.

Measuring the influence of Cooperative Learning and Project Based Learning on problem solvin skill.

The aim of this study is to evaluate the effects obtained after applying two active learning methodologies (cooperative learning and project based learning) to the achievement of the competence problem solving. This study was carried out at the Technical University of Madrid, where these methodologies were applied to two Operating Systems courses. The first hypothesis tested was whether the implementation of active learning methodologies favours the achievement of ?problem solving?. The second hypothesis was focused on testing if students with higher rates in problem solving competence obtain better results in their academic performance. The results indicated that active learning methodologies do not produce any significant change in the generic competence ?problem solving? during the period analysed. Concerning this, we consider that students should work with these methodologies for a longer period, besides having a specific training. Nevertheless, a close correlation between problem solving self appraisal and academic performance has been detected.

Supporting the design and development of Project Based Learning courses.

The use of Project Based Learning has spread widely over the last decades, not only throughout countries but also among disciplines. One of the most significant characteristics of this methodology is the use of ill-structured problems as central activity during the course, which represents an important difficulty for both teachers and students. This work presents a model, supported by a tool, focused on helping teachers and students in Project Based Learning, overcoming these difficulties. Firstly, teachers are guided in designing the project following the main principles of this methodology. Once the project has been specified at the desired level of depth, the same tool helps students to finish the project specification and organize the implementation. Collaborative work among different users is allowed in both phases. This tool has been satisfactorily tested designing two real projects used in Computer Engineering and Software Engineering degrees.

Strengthening and measuring project management competences of engineering students

Since 2010 the Industrial Engineering School at Universidad Politécnica de Madrid (ETSII UPM) has its Plan Study accredited by ABET. Since then a big motivation has been promoted from the management team encouraging teachers to work on the measurement and strengthening of student¿s competences. Generic skills or behavior acquired significant importance in the workplace, particularly in relation to project management. Because of this, and framed within the requirements of the European Higher Education Area (EHEA), the curriculum of the new degrees are being developed under the competence-based learning. This situation leads to the need to have a clear measurement tool skills as a basis for developing them within the curriculum. A group of multidisciplinary teachers have been working together during two years to design measuring instruments valid for engineering students.

Cooperative ITS communications architecture: the FOTsis project approach and beyond

With the continuous development in the fields of sensors, advanced data processing and communications, road transport oriented intelligent applications and services have reached a significant maturity and complexity. Cooperative ITS services, based on the idea of sharing accurate information among road entities, are currently being tested on a large scale by different initiatives. The field operational test (FOTsis) project contributes to the deployment environment with services that involve a significant number of entities out of the vehicle. This made necessary the specification of an architecture which, based on the ISO ITS station reference architecture for communications, could support the requirements of the services proposed in the project. During the project, internal implementation tests and external interoperability tests have resulted in the validation of the proposed architecture. At the same time, these tests have had as a result the awareness of areas in which the FOTsis architecture could be completed, mainly to take full advantage of all the emerging and foreseeable data sources which may be relevant in the road environment. In this study, the authors will outline an approach that, based on the current cooperative ITS architecture and the SmartCities and Internet Of Things (IoT) architectures, can provide a common convergence platform to maximise the information available for ITS purposes.

Conflict Resolution to Project Performance

Conflict resolution is a key issue to manage when dealing with diverse stakeholders. By analysing in depth the most relevant and implicit aspects of the construct "conflict", this study focuses on examining how the five main strategies in solving common disagreements are adopted by considering different conflict sources. Hypotheses are tested using data collected from both the academic and business world. Perceptions of project managers and team members allows the authors not only to find significant differences by role played or type of organization, but to narrow the design of future approaches to investigate the relation between conflict and project performance. More specifically, the research indicates that project managers adopt confronting and compromising styles in most cases as first options, highlighting the influence of responsibility degree factor in how issues are undertaken within a project team.