An action research strategy for selecting and conducting program evaluations.

Describes a strategy for school psychologists to use in selecting the types of program evaluation required to meet system needs. Dimensions of program evaluation—target, purpose, and stage—relevant to school psychologists are described and defined and combined into a conceptual framework indicating 48 different types of program evaluation. The proposed model incorporates relevant aspects of existing program evaluation strategies and action research, affording practitioners a strategy for selecting and conducting program evaluations. Suggested steps for implementing the action research strategy, as well as a hypothetical example of its use, are offered.

[Laboratory diagnostic with regard to new anticoagulants - monitoring and influence on coagulation tests]

New oral anticoagulants promise to overcome essential drawbacks of traditional substances. They have a predictable therapeutic effect, a wide therapeutic window, only limited interaction with food and drugs and can be administered p.o. with a fixed dose. On the other hand, knowledge on the laboratory management of new anticoagulants is limited. In the present article we discuss possible indications and available assays for monitoring of Rivaroxaban, Apixaban and Dabigatran. Furthermore, we discuss interpretation of routine coagulation tests during therapy with these new drugs.

Monitoring and Modeling of the Hydraulic and Sediment Processes at In-Stream Restoration Structures in the Vicinity of a Bridge Crossing

The long-term performance of infrastructure depends on reliable and sustainable designs. Many of Pennsylvania’s streams experience sediment transport problems that increase maintenance costs and lower structural integrity of bridge crossings. A stream restoration project is one common mitigation measure used to correct such problems at bridge crossings. Specifically, in an attempt to alleviate aggradation problems with the Old Route 15 Bridge crossing on White Deer Creek, in White Deer, PA, two in-stream structures (rock cross vanes) and several bank stabilization features were installed along with a complete channel redevelopment. The objectives of this research were to characterize the hydraulic and sediment transport processes occurring at the White Deer Creek site, and to investigate, through physical and mathematical modeling, the use of instream restoration structures. The goal is to be able to use the results of this study to prevent aggradation or other sediment related problems in the vicinity of bridges through improved design considerations. Monitoring and modeling indicate that the study site on White Deer Creek is currently unstable, experiencing general channel down-cutting, bank erosion, and several local areas of increased aggradation and degradation of the channel bed. An in-stream structure installed upstream of the Old Route 15 Bridge failed by sediment burial caused by the high sediment load that White Deer Creek is transporting as well as the backwater effects caused by the bridge crossing. The in-stream structure installed downstream of the Old Route 15 Bridge is beginning to fail because of the alignment of the structure with the approach direction of flow from upstream of the restoration structure.

Design and Use of an Alternative Fuel Testing Apparatus and Assessment of the Feasibility of Biodiesel

Petroleum supply and environmental pollution issues constantly increase interest in renewable low polluting alternative fuels. Published test results show decreased pollution with similar power output and fuel consumption from Internal Combustion Engines (ICE) burning alternative fuels. More specifically, diesel engines burning biodiesel derived from plant oils and animal fats not only reduce harmful exhaust emissions but are renewable and environmentally friendly. To validate these claims and assess the feasibility of alternative fuels, independent engine dynamometer and emissions testing was performed. A testing apparatus capable of making relevant measurements was designed, built, and used to test and determine the feasibility of biodiesel. The apparatus marks the addition of a valuable testing tool to the University and provides a foundation for future experiments. This thesis will discuss the background of biodiesel, testing methods, design and function of the testing apparatus, experimental results, relevant calculations, and conclusions.

State Pharmaceutical Assisstance for the Elderly and Disabled: Planning Issues for Program and Non-Program States

The Medicare Catastrophic Coverage Act (MCCA) would have mandated federal assistance for Medicare beneficiaries who have high annual prescription medication costs, High national expenditures for such drugs have encouraged the development of private and state insurance programs to help with these costs. Ten state pharmaceutical assistance programs (SPAPs), designed to help certain elderly, low income, or disabled people, exist for those ineligible for Medicaid or unable to purchase coverage privately. Coordination of state and federal benefits was a consideration for established programs, and programs being planned needed to determine the feasibity of integration of federal assistance. But the enactment and subsequent appeal of the Act affected both planning and policy implications for these SPAPs. All U.S. states and territories were surveyed before the bill's repeal to collect data on the effects of MCCA for those with prescription drug programs and those without. The repeal of the federal program places pressure on the nonprogram states to proceed, perhaps more cautiously, to initiate program; for their own residents, given increasing out-of-pocket and insurance costs, and no federal program.

Does Mental Illness Affect Consumer Direction of Community-Based Care? Lessons From the Arkansas Cash and Counseling Program

Purpose: Previous research from the Cash and Counseling Demonstration and Evaluation (CCDE) in Arkansas, New Jersey, and Florida suggests that giving consumers control over their personal care greatly increases their satisfaction and improves their outlook on life. Still, some argue that consumerdirected care may not be appropriate for consumers with intellectual disabilities or mental health diagnoses. This study examined how Cash and Counseling— a new option allowing consumers to manage an individualized budget equivalent to what agencies would have spent on their care—changes the way consumers with mental health diagnoses meet their personal care needs and how that affects their wellbeing. Design and Methods: Using the Arkansas CCDE baseline and the 9-month follow-up data for individuals in the treatment and control groups, we compared and contrasted the experience of elderly consumers with and without mental health diagnoses utilizing logit regression. Results: After examining several outcome measures, including satisfaction with care arrangements and the paid caregiver’s reliability and schedule, unmet needs, and satisfaction with the relationship with paid caregivers, this study found evidence that, from the perspective of consumers, the Cash and Counseling program works well for participants with mental health diagnoses. Implications: Considering the growing need for long-term-care services and the limited resources available, a consumer-directed option makes sense, and it can be a valuable alternative for persons with mental health needs.

Application and assessment of a robust elastic motion correction algorithm to dynamic MRI

The purpose of this study was to assess the performance of a new motion correction algorithm. Twenty-five dynamic MR mammography (MRM) data sets and 25 contrast-enhanced three-dimensional peripheral MR angiographic (MRA) data sets which were affected by patient motion of varying severeness were selected retrospectively from routine examinations. Anonymized data were registered by a new experimental elastic motion correction algorithm. The algorithm works by computing a similarity measure for the two volumes that takes into account expected signal changes due to the presence of a contrast agent while penalizing other signal changes caused by patient motion. A conjugate gradient method is used to find the best possible set of motion parameters that maximizes the similarity measures across the entire volume. Images before and after correction were visually evaluated and scored by experienced radiologists with respect to reduction of motion, improvement of image quality, disappearance of existing lesions or creation of artifactual lesions. It was found that the correction improves image quality (76% for MRM and 96% for MRA) and diagnosability (60% for MRM and 96% for MRA).

[Community-acquired pneumonia--pathogens and assessment]

Pneumonia is one of the most important infectious diseases, both in terms of incidence as well as potential severity. Streptococcus pneumoniae remains the most prevalent etiologic agent, accounting for about two-thirds of bacteremic cases. Diagnostic procedures include chest radiography, blood culture, Gram staining and culture of expectorated sputum, urine antigen assays for Legionella pneumophila and pneumococci, and asservation of an initial serum sample for comparative serologic investigations. Molecular biology techniques continue to gain importance for the diagnosis of Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionellae and viral respiratory infections, however, their availability at present is mainly restricted to research and reference laboratories.

Cerebral oxygenation in patients after severe head injury: monitoring and effects of arterial hyperoxia on cerebral blood flow, metabolism and intracranial pressure

Early impaired cerebral blood flow (CBF) after severe head injury (SHI) leads to poor brain tissue oxygen delivery and lactate accumulation. The purpose of this investigation was to elucidate the relationship between CBF, local dialysate lactate (lact(md)) and dialysate glucose (gluc(md)), and brain tissue oxygen levels (PtiO2) under arterial normoxia. The effect of increased brain tissue oxygenation due to high fractions of inspired oxygen (FiO2) on lact(md) and CBF was explored. A total of 47 patients with SHI were enrolled in this studies (Glasgow Coma Score [GCS] < 8). CBF was first assessed in 40 patients at one time point in the first 96 hours (27 +/- 28 hours) after SHI using stable xenon computed tomography (Xe-CT) (30% inspired xenon [FiXe] and 35% FiO2). In a second study, sequential double CBF measurements were performed in 7 patients with 35% FiO2 and 60% FiO2, respectively, with an interval of 30 minutes. In a subsequent study, 14 patients underwent normobaric hyperoxia by increasing FiO2 from 35 +/- 5% to 60% and then 100% over a period of 6 hours. This was done to test the effect of normobaric hyperoxia on lact(md) and brain gluc(md), as measured by local microdialysis. Changes in PtiO2 in response to changes in FiO2 were analyzed by calculating the oxygen reactivity. Oxygen reactivity was then related to the 3-month outcome data. The levels of lact(md) and gluc(md) under hyperoxia were compared with the baseline levels, measured at 35% FiO2. Under normoxic conditions, there was a significant correlation between CBF and PtiO2 (R = 0.7; P < .001). In the sequential double CBF study, however, FiO2 was inversely correlated with CBF (P < .05). In the 14 patients undergoing the 6-hour 100% FiO2 challenge, the mean PtiO2 levels increased to 353 (87% compared with baseline), although the mean lact(md) levels decreased by 38 +/- 16% (P < .05). The PtiO2 response to 100% FiO2 (oxygen reactivity) was inversely correlated with outcome (P < .01). Monitoring PtiO2 after SHI provides valuable information about cerebral oxygenation and substrate delivery. Increasing arterial oxygen tension (PaO2) effectively increased PtiO2, and brain lact(md) was reduced by the same maneuver.

Bloodstream infections in pediatric ECLS: usefulness of daily blood culture monitoring and predictive value of biological markers. The British Columbia experience

INTRODUCTION: The incidence of bloodstream infection (BSI) in extracorporeal life support (ECLS) is reported between 0.9 and 19.5%. In January 2006, the Extracorporeal Life Support Organization (ELSO) reported an overall incidence of 8.78% distributed as follows: respiratory: 6.5% (neonatal), 20.8% (pediatric); cardiac: 8.2% (neonatal) and 12.6% (pediatric). METHOD: At BC Children's Hospital (BCCH) daily surveillance blood cultures (BC) are performed and antibiotic prophylaxis is not routinely recommended. Positive BC (BC+) were reviewed, including resistance profiles, collection time of BC+, time to positivity and mortality. White blood cell count, absolute neutrophile count, immature/total ratio, platelet count, fibrinogen and lactate were analyzed 48, 24 and 0 h prior to BSI. A univariate linear regression analysis was performed. RESULTS: From 1999 to 2005, 89 patients underwent ECLS. After exclusion, 84 patients were reviewed. The attack rate was 22.6% (19 BSI) and 13.1% after exclusion of coagulase-negative staphylococci (n = 8). BSI patients were significantly longer on ECLS (157 h) compared to the no-BSI group (127 h, 95% CI: 106-148). Six BSI patients died on ECLS (35%; 4 congenital diaphragmatic hernias, 1 hypoplastic left heart syndrome and 1 after a tetralogy repair). BCCH survival on ECLS was 71 and 58% at discharge, which is comparable to previous reports. No patient died primarily because of BSI. No BSI predictor was identified, although lactate may show a decreasing trend before BSI (P = 0.102). CONCLUSION: Compared with ELSO, the studied BSI incidence was higher with a comparable mortality. We speculate that our BSI rate is explained by underreporting of "contaminants" in the literature, the use of broad-spectrum antibiotic prophylaxis and a higher yield with daily monitoring BC. We support daily surveillance blood cultures as an alternative to antibiotic prophylaxis in the management of patients on ECLS.