The relationship of public health nursing experience of the hospital nurse to her awareness of community resources and their services

Thesis (M.S.)--Boston Universit

Joseph S. Jenckes V to Senator James O. Eastland, 21 October 1976

Typed letter signed dated 21 October 1976 from Joseph S. Jenckes V, Special Assistant for Legislative Affairs, to Eastland, re: forwarding letter from students at Camden Elementary School. Attached: carbon typed letter dated 26 October 1976 from Ford to Dear Girls and Boys, re: America.https://egrove.olemiss.edu/joecorr_g/1082/thumbnail.jp

Joe Jenckes to Senator James O. Eastland, undated

Handwritten memorandum from Joe Jenkes to Eastland, re: veto. Attached: copy typed manuscript entitled Military Construction Authorization Veto H.R. 12384. Attached: White House press release dated 2 July 1976, re: above topic.https://egrove.olemiss.edu/joecorr_g/1076/thumbnail.jp

Joseph S. Jenckes V to Senator James O. Eastland, 22 October 1976

Typed letter signed dated 22 October 1976 from Joseph S. Jenckes V to Eastland, retirement age waiver for Ashton C. Barrett.https://egrove.olemiss.edu/joecorr_g/1083/thumbnail.jp

Variability of hydrogeochemistry and chemical weathering regimes in high latitude glacierized coastal catchments

Dissertation (Ph.D.) University of Alaska Fairbanks, 2023Accelerated modifications to the hydrology, driven by global climate change, will alter the timing and amount of freshwater discharged from coastal catchments to the intertidal and nearshore habitats of the Gulf of Alaska. Coastal glacierized catchments are important sources of both inorganic and organic matter to the nearshore ecosystem. The Gulf of Alaska is an ecologically diverse ecosystem, that supports commercial, mariculture, and subsistence lifestyles. However, the coastal catchments of the Gulf of Alaska are relatively understudied with respect to solute generation, seasonal cycles of major cations and anions, and chemical weathering regimes. To close the knowledge gap, the present study utilizes a unique set of stream samples compiled from field-based activities and the USGS NWIS from stream sites across the Gulf of Alaska watershed. First, we find that watershed characteristics such as slope, elevation and relief drive the variation in concentration-discharge relationships, while glacier coverage controls solute yields. Second, though glaciers control overall solute yields, the climate dictates the timing of seasonal solute yields. Additionally, we find across the Gulf of Alaska lithology and climate are important controls on major cation and anion concentrations. Finally, we implement a solute mass balance model to estimate fractional contributions to solute flux from silicate, carbonate and precipitation. We find that carbonate weathering is the dominant source of weathering derived solutes, however there are several streams across the Gulf of Alaska in which silicate weathering is an important source of solutes. Overall, the results of this work illustrate the variability in stream chemistry across the Gulf of Alaska, and changing climate regimes will alter the fluxes of solutes and nutrients in the future.Chapter 1. Introduction -- Chapter 2. Concentration-discharge patterns across the Gulf of Alaska reveal geomorphological and glacierization controls on stream water solute generation and export -- Chapter 3. Hydroclimate drives seasonal riverine export across a gradient of glacierized high-latitude coastal catchments -- Chapter 4. Characterization of geochemical weathering regimes across the Gulf of Alaska watershed -- Chapter 5. Conclusions

Contrasting Views of Physicians and Nurses about an Inpatient Computer-based Provider Order-entry System

Objective: Many hospitals are investing in computer-based provider order-entry (POE) systems, and providers’ evaluations have proved important for the success of the systems. The authors assessed how physicians and nurses viewed the effects of one modified commercial POE system on time spent patients, resource utilization, errors with orders, and overall quality of care. Design: Survey. Measurements: Opinions of 271 POE users on medicine wards of an urban teaching hospital: 96 medical house officers, 49 attending physicians, 19 clinical fellows with heavy inpatient loads, and 107 nurses. Results: Responses were received from 85 percent of the sample. Most physicians and nurses agreed that orders were executed faster under POE. About 30 percent of house officers and attendings or fellows, compared with 56 percent of nurses, reported improvement in overall quality of care with POE. Forty-four percent of house officers and 34 percent of attendings/fellows reported that their time with patients decreased, whereas 56 percent of nurses indicated that their time with patients increased (P \u3c 0.001). Sixty percent of house officers and 41 percent of attendings/fellows indicated that order errors increased, whereas 69 percent of nurses indicated a decrease or no change in errors. Although most nurses reported no change in the frequency of ordering tests and medications with POE, 61 percent of house officers reported an increased frequency. Conclusion: Physicians and nurses had markedly different views about effects of a POE system on patient care, highlighting the need to consider both perspectives when assessing the impact of POE. With this POE system, most nurses saw beneficial effects, whereas many physicians saw negative effects

Hydroclimate drives seasonal riverine export across a gradient of glacierized high-latitude coastal catchments

Glacierized coastal catchments of the Gulf of Alaska (GoA) are undergoing rapid hydrologic fluctuations in response to climate change. These catchments deliver dissolved and suspended inorganic and organic matter to nearshore marine environments, however, these glacierized coastal catchments are relatively understudied and little is known about total solute and particulate fluxes to the ocean. We present hydrologic, physical, and geochemical data collected during April–October 2019–2021 from 10 streams along gradients of glacial fed to non-glacial (i.e., precipitation) fed, in one Southcentral and one Southeast Alaska region. Hydrologic data reveal that glaciers drive the seasonal runoff patterns. The ẟ18O signature and specific conductance show distinctive seasonal variations in stream water sources between the study regions apparently due to the large amounts of rain in Southeast Alaska. Total dissolved solids concentrations and yields were elevated in the Southcentral region, due to lithologic influence on dissolved loads, however, the hydroclimate is the primary driver of the timing of dissolved and suspended yields. We show the yields of dissolved organic carbon is higher and that the δ13CPOC is enriched in the Southeast streams illustrating contrasts in organic carbon export across the GoA. Finally, we illustrate how future yields of solutes and sediments to the GoA may change as watersheds evolve from glacial influenced to precipitation dominated. This integrated analysis provides insights into how watershed characteristics beyond glacier coverage control properties of freshwater inputs to the GoA and the importance of expanding study regions to multiple hydroclimate regimes.National Science Foundation. Sloan Indigenous Graduate Partnership Fellowship.Abstract -- Key points -- 1. Introduction -- 2. Study region -- 3. Methods -- 4. Results -- 5. Discussion -- 6. Conclusions -- Acknowledgments -- Conflict of interest -- Open research -- Supporting information -- References.Ye

Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions

BACKGROUND: Despite awareness of inequities in health care quality, little is known about strategies that could improve the quality of healthcare for ethnic minority populations. We conducted a systematic literature review and analysis to synthesize the findings of controlled studies evaluating interventions targeted at health care providers to improve health care quality or reduce disparities in care for racial/ethnic minorities. METHODS: We performed electronic and hand searches from 1980 through June 2003 to identify randomized controlled trials or concurrent controlled trials. Reviewers abstracted data from studies to determine study characteristics, results, and quality. We graded the strength of the evidence as excellent, good, fair or poor using predetermined criteria. The main outcome measures were evidence of effectiveness and cost of strategies to improve health care quality or reduce disparities in care for racial/ethnic minorities. RESULTS: Twenty-seven studies met criteria for review. Almost all (n = 26) took place in the primary care setting, and most (n = 19) focused on improving provision of preventive services. Only two studies were designed specifically to meet the needs of racial/ethnic minority patients. All 10 studies that used a provider reminder system for provision of standardized services (mostly preventive) reported favorable outcomes. The following quality improvement strategies demonstrated favorable results but were used in a small number of studies: bypassing the physician to offer preventive services directly to patients (2 of 2 studies favorable), provider education alone (2 of 2 studies favorable), use of a structured questionnaire to assess adolescent health behaviors (1 of 1 study favorable), and use of remote simultaneous translation (1 of 1 study favorable). Interventions employing more than one main strategy were used in 9 studies with inconsistent results. There were limited data on the costs of these strategies, as only one study reported cost data. CONCLUSION: There are several promising strategies that may improve health care quality for racial/ethnic minorities, but a lack of studies specifically targeting disease areas and processes of care for which disparities have been previously documented. Further research and funding is needed to evaluate strategies designed to reduce disparities in health care quality for racial/ethnic minorities