Risk factors for and estimated incidence of community-associated Clostridium difficile infection, North Carolina, USA.

We determined estimated incidence of and risk factors for community-associated Clostridium difficile infection (CA-CDI) among patients treated at 6 North Carolina hospitals. CA-CDI case-patients were defined as adults (>18 years of age) with a positive stool test result for C. difficile toxin and no hospitalization within the prior 8 weeks. CA-CDI incidence was 21 and 46 per 100,000 person-years in Veterans Affairs (VA) outpatients and Durham County populations, respectively. VA case-patients were more likely than controls to have received antimicrobial drugs (adjusted odds ratio [aOR] 17.8, 95% confidence interval [CI] 6.6-48] and to have had a recent outpatient visit (aOR 5.1, 95% CI 1.5-17.9). County case-patients were more likely than controls to have received antimicrobial drugs (aOR 9.1, 95% CI 2.9-28.9), to have gastroesophageal reflux disease (aOR 11.2, 95% CI 1.9-64.2), and to have cardiac failure (aOR 3.8, 95% CI 1.1-13.7). Risk factors for CA-CDI overlap with those for healthcare-associated infection.

Multiple Response System: Evaluation of Policy Change in North Carolina's Child Welfare System.

Systemic challenges within child welfare have prompted many states to explore new strategies aimed at protecting children while meeting the needs of families, but doing so within the confines of shrinking budgets. Differential Response has emerged as a promising practice for low or moderate risk cases of child maltreatment. This mixed methods evaluation explored various aspects of North Carolina's differential response system, known as the Multiple Response System (MRS), including: child safety, timeliness of response and case decision, frontloading of services, case distribution, implementation of Child and Family Teams, collaboration with community-based service providers and Shared Parenting. Utilizing Child Protective Services (CPS) administrative data, researchers found that compared to matched control counties, MRS: had a positive impact on child safety evidenced by a decline in the rates of substantiations and re-assessments; temporarily disrupted timeliness of response in pilot counties but had no effect on time to case decision; and increased the number of upfront services provided to families during assessment. Qualitative data collected through focus groups with providers and phone interviews with families provided important information on key MRS strategies, highlighting aspects that families and social workers like as well as identifying areas for improvement. This information is useful for continuous quality improvement efforts, particularly related to the development of training and technical assistance programs at the state and local level.

Due to her tender age: Black girls and childhood on trial in South Carolina, 1885-1920

Drawing on local criminal court records in western and central South Carolina, this dissertation follows the legal experiences of black girls in South Carolina courts between 1885 and 1920, a time span that includes the aftermath of Reconstruction and the foundational years of Jim Crow. While scholars continue to debate the degree to which black children were included in evolving conversations about childhood and child protection, this dissertation argues that black girls were critical to turn-of-the century debates about all children's roles in society. Far from invisible in the courts and jails of their time, black girls found themselves in the crosshairs of varying forms of power --including intraracial community surveillance, burgeoning local government, Progressive reform initiatives and military policy -- particularly when it came to matters of sexuality and reproduction. Their presence in South Carolina courts established boundaries between early childhood, adolescence and womanhood and pushed legal stakeholders to consider the legal implication of age, race, and gender in criminal proceedings. Age had a complicated effect on black girls' legal encounters; very young black girls were often able to claim youth and escape harsher punishments, while courts often used judicial discretion to levy heavier sentences to adolescents and violent girl offenders. While courts helped to separate early childhood from the middle years, they also provided a space for African-American children and family to engage a legal system that was moving rapidly toward disenfranchising blacks.

Dramatic variability of the carbonate system at a temperate coastal ocean site (Beaufort, North Carolina, USA) is regulated by physical and biogeochemical processes on multiple timescales.

Increasing atmospheric carbon dioxide (CO2) from anthropogenic sources is acidifying marine environments resulting in potentially dramatic consequences for the physical, chemical and biological functioning of these ecosystems. If current trends continue, mean ocean pH is expected to decrease by ~0.2 units over the next ~50 years. Yet, there is also substantial temporal variability in pH and other carbon system parameters in the ocean resulting in regions that already experience change that exceeds long-term projected trends in pH. This points to short-term dynamics as an important layer of complexity on top of long-term trends. Thus, in order to predict future climate change impacts, there is a critical need to characterize the natural range and dynamics of the marine carbonate system and the mechanisms responsible for observed variability. Here, we present pH and dissolved inorganic carbon (DIC) at time intervals spanning 1 hour to >1 year from a dynamic, coastal, temperate marine system (Beaufort Inlet, Beaufort NC USA) to characterize the carbonate system at multiple time scales. Daily and seasonal variation of the carbonate system is largely driven by temperature, alkalinity and the balance between primary production and respiration, but high frequency change (hours to days) is further influenced by water mass movement (e.g. tides) and stochastic events (e.g. storms). Both annual (~0.3 units) and diurnal (~0.1 units) variability in coastal ocean acidity are similar in magnitude to 50 year projections of ocean acidity associated with increasing atmospheric CO2. The environmental variables driving these changes highlight the importance of characterizing the complete carbonate system rather than just pH. Short-term dynamics of ocean carbon parameters may already exert significant pressure on some coastal marine ecosystems with implications for ecology, biogeochemistry and evolution and this shorter term variability layers additive effects and complexity, including extreme values, on top of long-term trends in ocean acidification.

Mental Health and Substance Use Among Patients in a North Carolina HIV Clinic.

BACKGROUND: The HIV/AIDS epidemic is a significant public health concern in North Carolina, and previous research has pointed to elevated mental health distress and substance use among HIV-infected populations, which may impact patients' adherence to medications. The aims of this study were to describe the prevalence of mental health and substance use issues among patients of a North Carolina HIV clinic, to examine differences by demographic characteristics, and to examine factors associated with suboptimal adherence to HIV medications. METHODS: This study was a secondary analysis of clinical data routinely collected through a health behavior questionnaire at a large HIV clinic in North Carolina. We analyzed data collected from February 2011 to August 2012. RESULTS: The sample included 1,398 patients. Overall, 12.2% of patients endorsed current symptomology indicative of moderate or severe levels of depression, and 38.6% reported receiving a psychiatric diagnosis at some point in their life. Additionally, 19.1% had indications of current problematic drinking, and 8.2% reported problematic drug use. Nearly one-quarter (22.1%) reported suboptimal adherence to HIV medications. Factors associated with poor adherence included racial/ethnic minority, age less than 35 years, and indications of moderate or severe depression. LIMITATIONS: The questionnaire was not completed systematically in the clinic, which may limit generalizability, and self-reported measures may have introduced social desirability bias. CONCLUSION: Patients were willing to disclose mental health distress, substance use, and suboptimal medication adherence to providers, which highlights the importance of routinely assessing these behaviors during clinic visits. Our findings suggest that treating depression may be an effective strategy to improve adherence to HIV medications.

Evaluating Stakeholder Engagement in North Carolina Sea Grant’s Strategic Planning Process

In order to develop a strategic plan that will guide their priorities and resource allocation for 2018-2021, North Carolina Sea Grant has implemented a multi-stage process designed to increase stakeholder engagement and to better assess and serve the coastal priorities of North Carolinians. This project explores strengths and potential areas for improvement within NC Sea Grant’s planning process with a specific focus on maximizing stakeholder engagement. By interviewing staff, observing focus groups, and creating a survey instrument for public distribution, we developed a set of recommendations highlighting the ways that NC Sea Grant can better facilitate inclusion of stakeholder, public, and staff input in its strategic planning process, such as holding some stakeholder events outside of typical business hours and discussing ways to incorporate diversity into the strategic plan.

Propuesta preliminar de proyecto de desarrollo rural vinculado a los productores de llamas del departamento de Santa María provincia de Catamarca

La Argentina, Bolivia y Perú, son los países con mayor cantidad de camélidos sudamericanos, en Argentina hay guanacos, llamas y vicuñas. En la Patagonia se destaca la existencia de guanacos mientras que en la región del NOA (Catamarca, Jujuy, La Rioja, Salta, Santiago del Estero y Tucumán) se encuentran vicuñas y llamas. De estas tres especies, la llama es la que puede ser considerada doméstica. La característica endémica de este tipo de ganado en la región sur del continente americano y las condiciones de manejo en la Argentina, entre otras cuestiones, me impulsaron a elaborar la propuesta de un proyecto de desarrollo rural para Santa María de Catamarca, que tenga por población objetivo a los productores de llamas. El proyecto no fue llevado a la práctica. Dado que la elaboración del proyecto está en una etapa inicial y la idea es diseñarlo de forma participativa, el objetivo del trabajo es identificar cuales debieran ser los pasos a seguir en el diseño del proyecto para que el mismo se oriente a un proceso de desarrollo. Los avances se observan principalmente en el análisis de información de fuentes secundarias y entrevistas, de manera tal que permitió elaborar un marco de la situación y contexto. Además, se cuenta con la información obtenida de una dinámica de diagnóstico a través del árbol de problemas y soluciones efectuado con habitantes de la región donde se llevaría adelante el proyecto. Por lo tanto, este trabajo presenta al lector una propuesta preliminar de proyecto de desarrollo rural vinculado a los productores de llamas de Santa María de Catamarca y a su vez una propuesta metodológica sobre como se deberían llevar adelante las etapas que restan a fin de concretar un proyecto de desarrollo rural planificado de forma participativa.

Soybean response to toxic elements (chlorides, arsenates, fluorides and vanadates) naturally current in water and soil

p.59-70

Variaciones del proceso de desertificación en la cuenca del río Santa María, Catamarca

p.213-221

Análisis mesoclimático de las cartas topográficas Santa Rosa y Villa María (1:250.000) de la provincia de Córdoba (Argentina)

p.73-76

Soybean response to toxic elements (chlorides, arsenates, fluorides and vanadates) naturally current in water and soil

p.59-70

Indicadores de calidad de la tierra en distintas posiciones de la cuenca del Río Santa María

p.111-115

Desafios para o trabalho colaborativo nas aulas de estatística

Hoje encontramos estatística nos currículos de matemática da maioria dos países. Em Portugal, a estatística é ensinada nas aulas de matemática por um professor de matemática até ao ensino universitário. As orientações curriculares para o ensino da Estatística referem a necessidade de os alunos colocarem questões, recolherem, organizarem e representarem dados através de uma investigação. Uma forma de o fazer é implementando estratégias de trabalho colaborativo na sala de aula. Esta forma de trabalho cria oportunidades de enriquecer o poder estatístico dos alunos pois discutem e explicam ideias, expõem, avaliam e refutam argumentos e resoluções. Nesta comunicação procura-se reflectir sobre as vantagens do trabalho colaborativo nas aulas de estatística, incluindo a nossa própria investigação sobre o tema.