Program for increasing resident's physical activity at the women's home

Obesity and overweight has reached epidemic proportions in the United States, and the prevalence of overweight and obesity among residents of The Women's Home residents is high. This culminating experience is the result of my practicum at The Women's Home located in Houston, TX. The Women's Home is a rehabilitation center for victims of sexual assault, drug abuse, family violence, or a combination. A needs assessment including focus groups and a literature review was conducted to design a a physical activity intervention for the residents. Results from focus group data showed the resident's average BMI was 32, which is termed clinically obese by American standards. The focus groups determined a strong interest (92%) in engaging in more physical activity to combat their weight problem. As well, they expressed interest in using pedometers as a mechanism to increase physical activity. This planned program, “Every Step Counts”, uses reactivity to pedometers in conjunction with goal setting and increased awareness to increasing steps each day. “Every Step Counts” was developed with support and input from stakeholders, with theoretical constructs and previous evidence based studies. Included in this report are recommendations for implementation, program materials, scope and sequence of program activities, and methods for periodic evaluation.^

A systematic review of organizational workplace wellness programs and their financial and nonfinancial incentives

Workplace wellness programs have revealed immense beneficial results for both the employer and employee. Examples of results include decrease in absenteeism, turnover rate, medical claims and increases in employee satisfaction, productivity, and return on investment. However, the approach taken when implementing requires greater attention since such programs and the financial and/or non-financial incentives chosen have shown to significantly impact employee participation thus the amount of savings the organization experiences. A systematic review was conducted to evaluate the overall effectiveness of workplace wellness programs on employee health status and lifestyle change, recognize the majority types of returns observed by such programs, and identify whether financial or non-financial incentives created a greater effect on the employee. Overall employee health status improvement occurred when participating in wellness programs. The dominant indirect benefit for the organization was employee weight loss leading to a decrease in absenteeism and direct benefits included decreases in medical claims and increases in return on investment. In general, factors such as rate of participation and health status changes were most influenced when a financial incentives was provided in the wellness program. The basis of providing a program with effective incentives resides from efforts made by the employer and their efforts to play a role on every level of the organization regarding planning, implementing, and strategizing the most optimal approach for creating changes for the employees' wellbeing and productivity, thus the organizations overall returns.^

The success of worksite nutrition and physical activity interventions with environmental modifications A systematic review

Background: As obesity increases among U.S. workers, employers are implementing programs to increase physical activity and improve diets. Although programs to address individual determinants of obesity have been evaluated, less is known about the effects of workplace programs that change environmental factors, because most reviews have not isolated environmental programs; the one that did was published in 2005. ^ Objective: To update the 2005 review to determine the effectiveness of workplace environmental interventions. ^ Methods: The Medline database was searched for published English language reports (2003-2011) of randomized controlled (RCTs) or quasi-experimental trials (NRCTs) that evaluated strategies to modify physical activity opportunities or food services, targeting employees at least 18 years, not including retirees and that provided data for at least one physical activity, dietary, or health risk indicator. Three coders independently extracted study characteristics and scored the quality of study methods. Program effectiveness was determined using the 2005 review's best evidence approach. ^ Results: Seven studies represented in nine reports met eligibility criteria; three focused on diet and the remainder targeted diet and physical activity interventions. All but one study received a high quality score for internal validity. The evidence for the effectiveness of workplace environmental interventions was at best, inconclusive for diet and physical activity and limited for health risk indicators. The outcome constructs were inconsistent across the studies. ^ Conclusions: Limitations in the methods of the 2005 review made it challenging to draw conclusions about findings for this review that include: variation in outcome measures, reliance on distal measures without proximal behavior change measures, no distinction between changes at the workplace versus outside the workplace, and inappropriate analyses of cluster designs that biased findings toward statistical significance. The best evidence approach relied on vote-counting, using statistical significance alone rather than effect size and confidence intervals. Future research should address these limitations and use more rigorous methods; systematic reviews should use methods of meta-analysis to summarize study findings. These recommendations will help employers to better understand how environmental modifications in the workplace can support their efforts to combat the effects of obesity among employees.^

The cost effective management of Central Line-Associated Bloodstream Infections (CLABSIs) comparing the central line bundle to antimicrobialcoated central venous catheters: A systematic review

Central Line-Associated Bloodstream Infections (CLABSIs) are one of the most costly and preventable cases of morbidity and mortality among intensive care units (ICUs) in health care today. In 2008, the Centers for Medicare and Medicaid Services Medicare Program, under the Deficit Reduction Act, announced it will no longer reimburse hospitals for such adverse events among those related to CLABSIs. This reveals the financial burden shift onto the hospital rather than the health care payer who can now withhold reimbursements. With this weighing more heavily on hospital management, decision makers will need to find a way to completely prevent cases of CLABSI or simply pay for the financial consequences. ^ To reduce the risk of CLABSIs, several clinical, preventive interventions have been studied and even instituted including the Central Line (CL) Bundle and Antimicrobial Coated Central Venous Catheters (AM-CVCs). I carried out a formal systematic review on the topic to compare the cost-effectiveness of the Central Line (CL) Bundle to the commercially available antimicrobial coated central venous catheters (AM-CVCs) in preventing CLABSIs among critically and chronically ill patients in the U.S. Evidence was assessed for inclusion against predefined criteria. I, myself, conducted the data extraction. Ten studies were included in the review. Efficacy in reducing the mean incidence rate of CLABSI by the CL Bundle and AM-CVC interventions were compared with one another including costs. ^ The AM-CVC impregnated with antibiotics, rifampin-minocycline (AI-RM) is more clinically effective than the CL Bundle in reducing the mean rate of CLABSI per 1,000 catheter days. The lowest mean incidence rate of CLABSI per 1,000 catheter days among the AM-CVC studies was as low as zero in favor of the AI-RM. Moreover, the review revealed that the AI-RM appears to be more cost-effective than the CL Bundle. Results showed the adjusted incremental cost of the CL Bundle per ICU patient requiring a CVC to be approximately $196 while the AI-RM at only an additional cost of $48 per ICU patient requiring a CVC. ^ Limited data regarding the cost of the CL Bundle made it difficult to make a true comparison to the direct cost of the AM-CVCs. However, using the result I did have from this review, I concluded that the AM-CVCs do appear to be more cost-effective in decreasing the mean rate of CLABSI while also minimizing incremental costs per CVC than the CL Bundle. This review calls for further research addressing the cost of the CL Bundle and compliance and more effective study designs such as randomized control trials comparing the efficacy and cost of the CL Bundle to the AM-CVCs. Barriers that may face health care managers when implementing the CL Bundle or AM-CVCs include additional costs associated with the intervention, educational training and ongoing reinforcement as well as creating a new culture of understanding.^

Treatment modalities of female Operation Iraqi Freedom/Operation Enduring Freedom Veterans with posttraumatic stress disorder: A systematic review of the literature

Objective. To review professional literature regarding treatment modalities of post-traumatic stress disorder (PTSD) amongst female Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans, to assess the efficacy of these treatment options, and to summarize implications of the findings from this literature. Design. Systematic review of published literature. Data sources. Medline, Pubmed, Psycinfo. Review Methods. Articles selected for the literature review pertain to the treatment options of female OIF or OEF veterans who have a diagnosis of PTSD. In addition, other relevant articles, such as articles that discuss the prevalence of the problem, access to care, and similar treatment modalities for PTSD in other war settings, were selected for background information for the review. Results. The search strategy identified 1,305 potential journal articles, taken from thorough searches in Medline, Pubmed, and Psycinfo. These articles were then imported into Refworks. Following final screening, there were 18 articles included in the systematic review and 28 articles used as background information. The remaining articles were excluded following screening of abstract and/or full text of articles. Treatment modalities presented in these trials include: Exposure Therapy (average of 68% reduction in PTSD symptoms), Imagery Rehearsal Therapy (23% reduction), Body-Oriented Therapy (57% reduction), Electroconvulsive Therapy (35% reduction), Holographic Reprocessing (47% reduction), a self-defense training program (13% reduction), Cognitive Behavioral Therapy (65% reduction) and a variety of pharmacotherapies (antipsychotics at 81% reduction, sympatholytic drug at 100% reduction). Outcomes of the studies included in this systematic review were measured by using personal assessment of whether there was a reduction in symptoms of PTSD, based on the results in each study. Conclusion. Overall, all of the treatment modalities investigated in the systematic review proved to be somewhat effective in relieving the burden of symptoms of PTSD amongst female veterans of OIF/OEF. In addition to pharmacotherapy, which had the highest reduction in PTSD symptoms, both the Exposure Therapy and the Cognitive Behavioral Therapy techniques proved to have the most positive results. As all of the therapies had a positive effect on this population, to some degree, a study needs to be done in the future to compare and contrast the efficacy of each therapy intervention when applied to a standardized population.^

Supplemental Nutrition Assistance Program: A policy analysis of restricting foods with minimal nutritional value

In 2011, expenditures for the Supplemental Nutrition Assistance Program (SNAP) reached an all-time high of $72 billion. The goal of SNAP is " to alleviate hunger and malnutrition…by increasing food purchasing power for all eligible households who apply for participation." It has been well established that proper nutrition is essential to good health, making SNAP an important program to public health consumers. Thus, this analysis examined whether SNAP is meeting its stated goal and whether the goal would be reduced if the purchase of foods of minimal nutritional value (FMNV) were restricted. ^ A review of existing literature found that SNAP has been shown to alleviate hunger, but the studies on the nutritional impact of the program were not sufficient to assert whether change is needed. When considering whether limiting FMNV would reduce or improve the effectiveness of SNAP at alleviating hunger and malnutrition, there is very little information on which to base a policy change, particular one that singles out a low income group to restrict purchases. ^ Several states have attempted to restrict the purchase of FMNV but, to date, no such change has been implemented or tested. Conducting pilot studies on the restriction of FMNV, along with better data collection on SNAP purchases, would guide policy changes to the program. Although there are many potential public health benefits to restricting FMNV purchase using SNAP dollars, research is needed to quantify the cost impact of these benefits.^

A Critical Review of Opinion Polls relating to Iranian Voting Intentions: Problems of Research Methodology as applied to Complex Societies

After the 10th Iranian Presidential election on June 12, 2009, several public opinion polls taken in Iran attracted the attention of policy-makers and journalists around the world because of the political crisis that followed. In this paper I first review critically the polls conducted by the WPO (WorldPublicOpinion.org), PIPA (Program on International Policy Attitudes) at the University of Maryland. I also review an essay by Steven Kull, which is based on the aforementioned poll results and which in my opinion leads to false conclusions concerning Iran’s political prospects. I also discuss “An Analysis of Multiple Polls of the Iranian Public,” published by WPO-PIPA on February 3 2010. The present paper arrives at the overall conclusion that it is impossible to obtain an accurate image of political opinions in societies as complicated as that of Iran by concentrating on only one technique of research and analysis, especially when the political and social situation in the society concerned is in a state of constant flux.

Some design issues in the visualization of constraint logic program execution

Visualization of program executions has been found useful in applications which include education and debugging. However, traditional visualization techniques often fall short of expectations or are altogether inadequate for new programming paradigms, such as Constraint Logic Programming (CLP), whose declarative and operational semantics differ in some crucial ways from those of other paradigms. In particular, traditional ideas regarding flow control and the behavior of data often cannot be lifted in a straightforward way to (C)LP from other families of programming languages. In this paper we discuss techniques for visualizing program execution and data evolution in CLP. We briefly review some previously proposed visualization paradigms, and also propose a number of (to our knowledge) novel ones. The graphical representations have been chosen based on the perceived needs of a programmer trying to analyze the behavior and characteristics of an execution. In particular, we concéntrate on the representation of the program execution behavior (control), the runtime valúes of the variables, and the runtime constraints. Given our interest in visualizing large executions, we also pay attention to abstraction techniques, Le., techniques which are intended to help in reducing the complexity of the visual information.

Relevance evaluation of engineering masters program in Peru

In a context of mass higher education, it is necessary to ensure not only quality but also the relevance of engineering master's programs, namely the appropriateness of the objectives and outcomes to the needs and interests of the program beneficiaries. After a literature review we analyzed the evaluation models of three organizations in Peru: the Board of Evaluation, Accreditation and Certification of the University Education Quality CONEAU, the Institute of Quality and Accreditation of Computing, Engineering and Technology - ICACIT and the Pontificia Universidad Catolica del Peru. The result of this study is a model for relevance evaluation for an engineering master¿s program in Peru.

An un-mounted horse care group for children and youth with an Autism Spectrum Disorder: Recommendations for program development and treatment intervention

Equine Assisted Activities and Therapies (EAAT) including Therapeutic Horseback Riding (THR) and un-mounted equine assisted activities are interventions aimed at improving the daily functioning and success of individuals with disabilities, including those with an autism spectrum disorder (ASD). While THR is frequently utilized as a treatment intervention for children with ASD, there are many limitations (individual's weight, horse health, weather, physical limitations, health conditions, etc.) that prevent this population from participating in mounted programs. Un-mounted equine assisted activities are often utilized as an alternative, but they are not informed by empirical research or a standardized treatment model. This paper provides a comprehensive review of the literature for EAAT including un-mounted programs, examination of organizational guidelines as they apply to un-mounted programs, and consultation with program directors regarding current practices in the field, and finally it establishes recommendations for the development of a standard curriculum that would strengthen un-mounted horse care group programs serving children with ASD.

Correlates of Program Completion in Juvenile Diversion

The current study evaluated the State Juvenile Diversion Program, managed by the District Attorney’s (DA) office in Denver Colorado. The purpose of this study was to review factors, which potentially contribute to success or failure in diversion. Research in diversion programing typically focuses on recidivism rates, but fails to examine which factors contribute to program completion. The analysis was conducted using data from 57 juveniles who entered the DA diversion program in 2015. This represents the majority of juveniles in the diversion program rather than a sample. The current study confirmed prior research findings that those juveniles who do not successfully complete a diversion program are more likely to reoffend. Additionally, the factors which were significantly correlated with successful completion of the diversion program were grade point average (GPA) and number of municipal tickets. The number of behavior reports in school before and after the Diversion program was significantly lower for both groups. Non-significant findings are also discussed as they may help guide future research.

The Creation of a Legal Ordinance and Program Manual for the Purpose of Illicit Discharge Detection and Elimination

Illegal dumping and improper disposal of pollutants in urban areas can contribute significant pollutant loads to the municipal separate storm sewer system (MS4) and natural environments. Illicit discharges to the MS4 can pose a significant risk to human and environmental health. The Clean Water Act requires that municipalities implement a legal mechanism and plan to detect and eliminate illicit discharges to the MS4. The methodology for program creation included the analysis of other municipal illicit discharge programs, review of state and federal guidance publications, and the review of illicit discharge case-studies. This paper describes a systematic approach applied to the creation and implementation of a legal ordinance and program manual designed for the purpose of illicit discharge detection and elimination (IDDE).

Development of a Household Pharmaceutical Waste Collection Program for Atlanta, Georgia: An Analysis of Risk Factors and Public Awareness with a Comprehensive Collection Plan

Decades of mixed messages from three federal agencies left many Americans unaware of the hazards associated with the indiscriminate disposal of unwanted or expired medicines. For this Capstone project, a systematic review of state and federal regulations was undertaken to determine how these laws obstruct household pharmaceutical waste collection. In addition, a survey of 654 Atlanta residents was conducted to evaluate unwanted medicine disposal habits, awareness of pharmaceutical compounds being detected in drinking water, surface, and ground waters, and willingness to participate in a household pharmaceutical waste collection program. Survey responses were tabulated to provide overall results and by age group, gender, and race. A household pharmaceutical waste collection plan was developed for the city and included as an appendix.

Review and Recommendations for Fast-Track Wetland Permitting for Petroleum Pipeline Maintenance

The petroleum pipeline industry in the United States is challenged with maintaining the integrity of their pipelines, while also protecting the environment during any pipeline repairs. This project provides information on the activities relating to the industry Integrity Management Program, assesses the process that federal agencies are developing to create streamlined permitting processes, and if the necessary federal, state, and local wetland permits can be obtained in the time frame required by the law. Recommendations are also made for implementation of a fast-track wetland permitting process and what pipeline companies can do to speed up the permitting process. This project focuses on the refined petroleum pipelines that originate near the Gulf of Mexico and terminate in the Northeastern United States.

A review of thermochemical conversion of microalgae

Microalgae are very effective microorganisms for CO2 capturing and a promising source of lipids for biodiesel as well as other interesting compounds. Many different ways of exploitation of these organisms are being tested. This work presents a review of the state of the art of the research and development of thermochemical conversion of microalgae with a special focus on pyrolysis and hydrothermal liquefaction. Aspects related to the type of reactors, the products obtained and the analytical applications are covered. The actual reaction scheme of pyrolysis of microalgae is extremely complex because of the formation of over hundreds of intermediate products. Various kinetic models reported in the literature and in a previous study with experimental validations are presented in this review to provide the current status of the study.