2009 Alaska Health Workforce Vacancy Study

Alaska continues to experience health professional shortages. The state has long had a deficient “supply side” characterized by insufficient numbers of key health workers whose recruitment, retention, and training have been impeded by Alaska’s remoteness, harsh climate, rural isolation, low population density, and scarce training resources. Alaska is the only state without a pharmacy school and lacks its own dental and physical therapy schools as well. Health professional shortages can be decreased through the start of new training programs, the expansion of existing programs, and the improvement of the effectiveness of recruitment and retention efforts. However, strategic planning and the execution of such programs require valid and accurate data. To this end, stakeholders such as the Alaska Mental Health Trust Authority (AMHTA) and Alaskan's For Access to Health Care (ACCESS), along with schools and departments within the University of Alaska Anchorage (UAA), funded the Alaska Center for Rural Health-Alaska’s AHEC (ACRH) and the Institute of Social and Economic Research (ISER) to conduct a comprehensive health workforce study during winter and spring of 2009. This report highlights employers’ needs for employees to fill budgeted positions. This is different from a needs assessment that would take into account population demographics and disease incidence and prevalence. This health workforce study is an assessment of health manpower shortage based on budgeted staff positions and their vacancies in organizations throughout the state. Respondents included part-time positions, which resulted in our counting full-time equivalent (FTE) rather than individuals (“bodies”). In situations where a position was divided among more than one occupation (e.g., Dental Assistant and Billing Clerk), we asked the respondent to count the position under which they considered the position’s “primary occupation.” This was a point-in-time cross-sectional study. Recently filled vacancies or imminent vacancies were not counted. Positions filled by relief/temporary/locum/contract health workers were counted as vacancies only if these workers were temporarily filling a currently vacant, budgeted position. Due to budget and time constraints, we were not able to conduct a trend analysis that is a comparison of this study’s findings and the prior 2007 study. The key questions this study sought to answer were (1) How many budgeted positions, either full- or part-time, existed in organizations providing health services in Alaska? (2) How many of these budgeted positions were currently vacant? (3) What was the vacancy rate? (4) How many of the organizations that employ these occupations hired new graduates of training programs? (5) How many of the currently vacant budgeted positions (#2) could be filled by new graduates of training programs? (6) What were the mean and maximum length of time, expressed in months, that the vacancies have existed? (7) What were the principal, underlying causes of vacancies? The study was designed in consultation with an advisory group that included AMHTA, ACCESS, and UAA. The study targeted 93 health occupations. The unit of analysis was the employment site by organization type, which allowed for the allocation of positions and vacancies by geographic region. For each employer, we identified the staff person most knowledgeable about hiring and vacancies. In large organizations this meant that one employer might provide information about multiple sites and organization types; smaller employers were responsible for only a single site.Alaska Mental Health Trust Authority. Alaskan's for Access to Health Care. University of Alaska Fairbanks, Tanana Valley campus Telemedicine program. University of Alaska Anchorage, Community and Technical College. University of Alaska Anchorage, School of Nursing.Acknowledgements / Executive Summary / Table of Contents / Problem and Rationale / Methodology / Limitations of Study / Findings / Appendix A. List of Health Occupations / Appendix B. Health Workforce Surveys / Appendix C. Cover Letter Accompanying Survey Forms / Appendix D. Confidence Intervals for Positions, Vacancies, Number of Vacancies Filled with New Graduates, and Length of Longest Vacancy in Months / Appendix E. Tables of Samples and Estimates of Positions, Vacancies, Vacancy Rates, Number of Vacancies Filled with New Graduates, Mean and Maximum Length of Longest Vacancy in Months / Appendix F. Tables of Occupations Sorted By Estimates of Positions, Vacancies, Vacancy Rates, Number of Vacancies Filled with New Graduates, Mean and Maximum Length of Longest Vacancy in Month

Tests for causes of rarity in goldenseal (Hydrastis canadensis L.)

Hydrastis canadensis L. (goldenseal) is becoming more uncommon within the eastern deciduous forest. I performed a series of studies that tested hypotheses about population decline and causes of rarity. First, I assessed the time-trend of a natural H. canadensis population in an Indiana nature preserve which had been censused 26 years prior. We found a negative population trajectory between the two time periods. The second goal of this dissertation was to determine the breeding system of H. canadensis. The breeding system type appears unlikely to be a major factor limiting the distribution or abundance of H. canadensis. My third objective was to assess the response of H. canadensis populations to harvest. I found variation in patch regrowth which suggests timing of harvest may be important. My studies in chapter 5 focused on abiotic microsite factors. I experimentally assessed the role of temperature, humidity, and light gradients in the distribution of H. canadensis. The relatively weak association between environmental variation and plant performance across the forested cove reinforces other studies suggesting that H. canadensis has a relatively broad ecological niche, and its rarity is unlikely due to availability of suitable abiotic habitat conditions. My fifth goal was to understand ecologically relevant aspects of H. canadensis genetics. I determined if H. canadensis contained ecologically important genetic variation (i.e. ecotypic differentiation) at the population level. I conducted a classical reciprocal transplant experiment with four natural populations to test the hypothesis that ramets planted in their home site would have greater survival and performance than alien H. canadensis ramets planted into the same site. This research is the basis of Chapter 6. My final goal was to determine whether H. canadensis range is limited due to high habitat specificity and limited availability of suitable habitat. This study found no evidence of a lack of suitable habitat for H. canadensis. Overall, these studies serve to rule out several possible causes of rarity of H. canadensis, although this research does suggest some role of understory light availability in species decline. This idea, along with other hypotheses, is discussed further in the general conclusions

Architectural Style on St Eustatius

AnthropologyMaster of Arts (M.A.

Behavioral effects of irreversible dopamine receptor inactivation in the preweanling rat: assessment of the receptor reserve hypothesis

EEDQ is an irreversible receptor antagonist that eliminates the dopamine (DA) mediated behaviors of adults rats. In contrast, EEDQ does not seem to affect the DA mediated behaviors of preweanling rat pups. One explanation for this age dependent difference is that rat pups may have a DA receptor reserve, not available to adults, which is sufficient to mediate behavior. Therefore, the purpose of the present study was to determine whether a Di and D2 receptor reserve exists in preweanling rats. A total of 96, 17-dayold rat pups were injected with EEDQ (7.5 mg/kg) or its vehicle immediately after being trained to approach an anesthetized dam on a straight alley for nipple attachment reward. After 18 hours rat pups were then injected with saline, the D1 agonist SCH 23390 (0.5 mg1kg), or the D2 agonist sulpiride (50 mg/kg). A final testing session occurred 30 min later. This session consisted of an additional 28 trials on the straight alley, in which responding resulted in either reinforcement or extinction. Results of this experiment indicated that EEDQ and SCH 23390 combined to maximally disrupt the extinction responding of the rat pups. Unexpectedly, EEDQ did not potentiate sulpiride\u27s effects. In general, these results indicate that preweanling rat pups do not have a DI or D2 receptor reserve, but age-dependent differences in DA receptor functioning were apparent

Evaluation of the Simple Wetting Method to Reduce Total Cyanogens in Flaxseed

A simple wetting method used to significantly reduce the % total cyanide remaining (TCR) in cassava was evaluated for its applicability to flaxseed. An optimal simple wetting method (SWM) in terms of time, temperature, and exposed surface area (SA) depth was developed for reducing the % TCR in ground flaxseed. The optimal parameters were a treatment time of 12 h, an ambient temperature of approximately 22°C, and an increased exposed SA achieved through spreading the wetted flaxseed mixture out to a thin depth of 0.5 cm. General mixed model analysis confirmed that the variables time and SA were significant factors in minimizing the %TCR in the optimal model. Pairwise comparison showed that the 0.5 cm depth had the greatest effect. The desirable lignan secoisolariciresinol diglucoside (SDG) was significantly retained, as determined by HPLC quantification of pre- and post-processing levels

Aptamer-based multiplexed proteomic technology for biomarker discovery

Interrogation of the human proteome in a highly multiplexed and efficient manner remains a coveted and challenging goal in biology. We present a new aptamer-based proteomic technology for biomarker discovery capable of simultaneously measuring thousands of proteins from small sample volumes (15 [mu]L of serum or plasma). Our current assay allows us to measure ~800 proteins with very low limits of detection (1 pM average), 7 logs of overall dynamic range, and 5% average coefficient of variation. This technology is enabled by a new generation of aptamers that contain chemically modified nucleotides, which greatly expand the physicochemical diversity of the large randomized nucleic acid libraries from which the aptamers are selected. Proteins in complex matrices such as plasma are measured with a process that transforms a signature of protein concentrations into a corresponding DNA aptamer concentration signature, which is then quantified with a DNA microarray. In essence, our assay takes advantage of the dual nature of aptamers as both folded binding entities with defined shapes and unique sequences recognizable by specific hybridization probes. To demonstrate the utility of our proteomics biomarker discovery technology, we applied it to a clinical study of chronic kidney disease (CKD). We identified two well known CKD biomarkers as well as an additional 58 potential CKD biomarkers. These results demonstrate the potential utility of our technology to discover unique protein signatures characteristic of various disease states. More generally, we describe a versatile and powerful tool that allows large-scale comparison of proteome profiles among discrete populations. This unbiased and highly multiplexed search engine will enable the discovery of novel biomarkers in a manner that is unencumbered by our incomplete knowledge of biology, thereby helping to advance the next generation of evidence-based medicine

Observations of Arp 220 using Herschel-SPIRE: An Unprecedented View of the Molecular Gas in an Extreme Star Formation Environment

We present Herschel SPIRE-FTS observations of Arp~220, a nearby ULIRG. The FTS continuously covers 190 -- 670 microns, providing a good measurement of the continuum and detection of several molecular and atomic species. We detect luminous CO (J = 4-3 to 13-12) and water ladders with comparable total luminosity; very high-J HCN absorption; OH+, H2O+, and HF in absorption; and CI and NII. Modeling of the continuum yields warm dust, with T = 66 K, and an unusually large optical depth of ~5 at 100 microns. Non-LTE modeling of the CO shows two temperature components: cold molecular gas at T ~ 50 K and warm molecular gas at T ~1350 K. The mass of the warm gas is 10% of the cold gas, but dominates the luminosity of the CO ladder. The temperature of the warm gas is in excellent agreement with H2 rotational lines. At 1350 K, H2 dominates the cooling (~20 L_sun/M_sun) in the ISM compared to CO (~0.4 L_sun/M_sun). We found that only a non-ionizing source such as the mechanical energy from supernovae and stellar winds can excite the warm gas and satisfy the energy budget of ~20 L_sun/M_sun. We detect a massive molecular outflow in Arp 220 from the analysis of strong P-Cygni line profiles observed in OH+, H2O+, and H2O. The outflow has a mass > 10^{7} M_sun and is bound to the nuclei with velocity < 250 km/s. The large column densities observed for these molecular ions strongly favor the existence of an X-ray luminous AGN (10^{44} ergs/s) in Arp 220.Comment: Accepted in ApJ on September 1, 201

A Workflow Approach To Information Systems Development

How businesses evolve and the technology available to them has changed in response to changing competitive environments. Organizations compete in global markets and must maintain international communication and operations. In the 1990\u27s, continued globalization and increasingly competitive markets will call for rapid responses and innovative thinking. In this turbulent environment, information technology will leverage time and human resources. (The Landmark MIT Study: Management in the 1990\u27s). While technology is available to link organizations around the world, the traditional development models and techniques for such systems are outmoded. Current systems analysis and design techniques needto be improved. According to a survey of senior information systems executives, improving the systems-development process is ranked sixth in the top issues facing North America and Europe. Improving information-services personnel is ranked ninth in North America and eighth in Europe (Sager, 1994). The purpose of this paper is to present a workflow approach of information systems development (WFSAD: Workflow Systems Analysis and Design) that incorporates an emphasis on analyzing business processes to improve processing time and focuses on developing integrated systems throughout and beyond organizational boundaries. A framework for analyzing the impact of the WFSAD approach on the management of information systems personnel is also presented