Conceptual model of salt marsh management on Merritt Island National Wildlife Refuge, Florida: final report

Diking and holding water on salt marshes ("impounding" the marsh) is a management technique used on Merritt Island National Wildlife Refuge (MINWR) and elsewhere in the Southeast to: a) prevent the reproduction of saltmarsh mosquitos, and b) attract wintertering waterfowl and other marsh, shore, and wading birds. Because of concern that diking and holding water may interfere with the production of estuarine fish and shellfish, impoundment managers are being asked to consider altering management protocol to reduce or eliminate any such negative influence. How to change protocol and preserve effective mosquito control and wildlife management is a decision of great complexity because: a) the relationships between estuarine organisms and the fringing salt marshes at the land-water interface are complex, and b) impounded marshes are currently good habitat for a variety of species of fish and wildlife. Most data collection by scientists and managers in the area has not been focused on this particular problem. Furthermore, collection of needed data may not be possible before changes in protocol are demanded. Therefore, the purpose of this document is two-fold: 1) to suggest management alternatives, given existing information, and 2) to help identify research needs that have a high probability of leading to improved simultaneous management of mosquitos, waterfowl, other wildlife, freshwater fish, and estuarine fish and shellfish on the marshland of the Merritt Island National Wildlife Refuge. (92 page document

Categorized bibliography for a conceptual model of salt marsh management on Merritt Island, Florida

Enclosed is a bibliography of 556 published articles, technical reports, theses, dissertations, and books that form the basis for a conceptual model of salt marsh management on Merritt Island, Florida (Section 1). A copy of each item is available on file at the Florida Cooperative Fish and Wildlife Research Unit, Gainesville. Some relevant proprietary items and unpublished drafts have not been included pending permission of the authors. We will continue to add pertinent references to our bibliography and files. Currently, some topics are represented by very few items. As our synthesis develops, we will be able to indicate a subset of papers most pertinent to an understanding of the ecology and management of Merritt Island salt marshes. (98 page document

Utilizing Doppler Ultrasound to Detect Arteriole Blood Flow Within the Median Nerve Sheath

Diagnostic medical sonographers (DMS) are at an increased risk for developing work-related musculoskeletal disorders, such as carpal tunnel syndrome (CTS). CTS is characterized by inflammation of the median nerve within the carpal tunnel and a literature review supports that hypervascularization is seen within the nerve sheath. Currently, only invasive procedures such as nerve conduction testing and dynamic contrast magnetic resonance imaging are utilized in diagnosing CTS. This feasibility study was the first of its kind to detect and quantify arteriole blood flow within the median nerve with spectral and power Doppler ultrasound. Five DMS had their wrists scanned with a hand carried ultrasound unit over a 10-week period both before and after scanning neonatal heads. The results showed the qualitative measure of blood flow with color Doppler was consistently seen on each scanning session, whereas the quantitative measure with spectral Doppler was obtained only half of the time. The pre and post measures of peak systolic (PS) velocity and end diastolic (ED) velocity were not statistically significant, but showed very low blood flow on average - PS = 4.36 cm/s and ED = 0.76 cm/s. While these measures were not consistently obtained, this study proved acquiring quantitative blood flow within the median nerve with spectral Doppler ultrasound is feasible. There were many limitations of this study and key among these was the short evaluation, nested inside a larger work day. This was a feasibility study; therefore a more rigorous controlled study is needed to find the true sensitivity of spectral Doppler ultrasound to quantify blood flow in the median nerve. A longitudinal and comprehensive data collection is needed that reflects the entire work load. Therefore, this research underlines the importance of understanding the related physiology and technique to find a noninvasive alternative in diagnosing CTS.No embarg

A Mixed Methods Study of Endometriosis: Patient Experience and Provider Awareness

Endometriosis is a serious yet understudied medical condition impacting hundreds of millions of women around the world. We used a mixed methods approach to better understand provider’s perceptions of the disease, as well as patient’s experiences with the disease. The study consisted of two parts. The first was a quantitative analysis of providers, in which participants completed a brief survey to assess their perception of the prevalence of endometriosis. Fifty-three providers completed surveys. Analysis of the survey data included calculating means and frequencies of each item, as well as determining providers’ prevalence estimates of endometriosis and whether this estimate varied by sub-specialty, number of years in practice, and gender. All quantitative analyses were conducted using SPSS. Survey results indicated that only six of the 53 providers accurately identified the prevalence of endometriosis. The second part of the study involved in-depth, qualitative interviews with both providers and patients. Four providers and 12 patients participated in the interview process. For the provider and patient interviews, code books were created and used to analyze the responses to identify recurring themes. Emergent themes in the provider interviews included, limited training about endometriosis, the difficulty of making a diagnosis, referral process, patient-provider dynamic, and the importance of multidisciplinary collaboration. Emergent themes from patients included, the mental aspect of the disease, lack of confidence in the healthcare system, concerns about fertility, self-advocacy, quality of life, being adverse to hormonal therapies, feelings of dismissiveness by providers, the financial impact of the disease, limited treatment options, and lack of awareness. Findings of this study highlighted some of the major issues which currently contribute to its public health burden, and can allow clinicians to foster change in their current practice with the aim of increasing awareness, issuing more timely and accurate diagnoses, and a call to action for investment and funding for research that will move the field forward and ultimately improve patient outcomes

PARENTAL UNDERSTANDING OF ANESTHESIA RISK FOR DENTAL TREATMENT

Purpose: To determine which method of anesthesia risk presentation parents understand and prefer across their demographic variables Methods: As a cross-sectional study, questionnaires were distributed to 50 parents of patients (\u3c7 years of age) in the VCU Pediatric Dental Clinic. Parents were asked of their own and their children’s demographics, previous dental and anesthesia experiences, and anesthesia understanding. Parents were then asked to rate the level of risk of several risk presentations and finally asked which method of risk presentation they most understood or preferred. Data analysis was performed using descriptive statistics, correlation coefficients, likelihood chi square tests, and repeated measures logistic regression. Results: There was no evidence of a differential preference due to gender (P = 0.28), age (P \u3e .9), education (P = 0.39) or whether they incorrectly answered any risk question (P \u3e 0.7). There was some evidence that the three types were not equally preferred (likelihood ratio chi- square = 5.31, df =2, P-value = 0.0703). The best estimate is that 60% prefer charts, 34% prefer numbers, and 36% prefer activity comparisons. There was a relationship between the average relative risk of general anesthesia and age (r = –0.38, P = 0.0070). Younger individuals indicate High risk more often and older individuals indicate Low risk more often. Conclusion: There was no preference of risk presentation type due to gender, age, or education, but there was evidence that each was not equally preferred. Healthcare providers must be able to present the risk of anesthesia in multiple ways to allow for full patient understanding

Shedding Light on Endometriosis: Patient and Provider Perspectives on a Challenging Disease

Background: Endometriosis is a serious yet understudied medical condition impacting millions of women worldwide. Methods: This mixed methods study aimed to understand health care provider perceptions and patient experiences with endometriosis in the United States. Providers were surveyed to assess their understanding of disease prevalence. A subset of providers also participated in short, open-ended interviews about treating patients who have or are suspected to have endometriosis. Interviews were also conducted with women diagnosed with endometriosis to understand their experiences with the disease. Means and frequencies were calculated for survey data; interviews were transcribed and separately analyzed by two coders using an iterative coding process until agreement was reached. Results: Fifty-three providers completed surveys. Six out of 53 providers (11%) accurately identified the prevalence of endometriosis. Four providers and 12 patients completed interviews. Emergent themes among providers included limited training, difficulty of diagnosis, complexity of the referral process, a challenging patient-provider dynamic, and the importance of multidisciplinary collaboration. Emergent themes from patients included the psychological impact of the disease, difficulties interacting with the healthcare system, self-advocacy, quality of life, and limited treatment options. Conclusion: Providers are frequently unfamiliar with the far-reaching scope of endometriosis and cite many challenges caring for patients with the disease. Patients equally find the disease challenging to live with as it encroaches on physical, mental, and emotional well-being

Associations Between Chronic Pain and Use of Pharmacotherapy for Smoking Cessation

Chronic pain and tobacco dependence are two highly prevalent and comorbid conditions. The rate of smoking among persons in pain may be greater than twice the rate observed in the general population. Smokers tend to experience more adverse pain-treatment outcomes than do nonsmokers, and there is mounting evidence to suggest that smokers with comorbid pain disorders may have more difficulty abstaining from tobacco. The main goal of the current study was to examine cross-sectional relations between chronic pain status and past use of pharmacotherapy for smoking cessation. We also tested associations between chronic pain status and frequency of past quit attempts. Data were derived from a nationally-representative survey of households in the continental United States. After adjusting for sociodemographic factors, substance use, mood and anxiety disorders, and number of attempts to quit smoking, smokers with chronic pain were found to be 1.67 times more likely to endorse past use of pharmacotherapy for smoking cessation, relative to smokers with no chronic pain. Chronic pain status was not associated with number of past attempts to quit smoking. These data suggest that smokers with chronic pain are motivated to quit smoking, and may be particularly amenable to pharmacologic intervention. Results are discussed with regard to clinical implications and directions for future research

Photographic analysis of natural and impounded salt marsh in the vicinity of Merritt Island, Florida

Qualitative analyses of available photographs and maps of Merritt Island, Florida provide a large-scale, historical perspective of ecological changes of the marshes in the vicinity. Sites that deserve closer scrutiny can be identified. Secondarily, such an analysis provides a geographical orientation essential for communication not only between newcomers and those familiar with the area, but also among those familiar with the area but who refer to sites by differing methods. Photographs and maps from various sources were examined. Below are listed what we consider to be the most useful subset of these for ecological and geographical assessment of salt marsh impoundments on Merritt Island, Florida. (Document has 25 pages.

Obstacles and Challenges to Implementing Multi-departmental QI at a Large, Academic Training Center-Lessons Learned from a HCV Screening Program

Objectives: We aimed to double the HCV screening rate of ‘baby-boomers’ admitted to the medicine teaching service at Methodist Hospital over the course of 6 months and demonstrate improved linkage to care for HCV RNA+ individuals. Initial efforts were a collaboration between Emergency Medicine, where faculty had experience implementing an HIV screening program, and Gastroenterology, a key stakeholder in linkage to care. Our pilot period coincided with new state regulations mandating that hospitals implement HCV screening for inpatients. These new regulations dramatically altered the scope and goals of the project.https://jdc.jefferson.edu/patientsafetyposters/1030/thumbnail.jp