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Background: The World Health Organization (WHO) introduced the International Classification of Functioning, Disability, and Health (ICF) as a scientific method of disability data collection comprised of >1,200 categories describing the spectrum of impairment types (functional, symptoms-based and anatomical) under the bio-psycho-social model with consideration of environmental and personal factors (pf). ICF Core Sets and ICF Checklists are streamlined disease-specific resources for clinical use, service provision, and for use in health economics and health policy. ICF can disclose strengths and weaknesses across multiple patient-reported outcome measures (PROMs) and help consolidate best-fitting question-items from multiple PROMs. Interstitial lung diseases (ILDs), are generally progressive, with restrictive physiology sometimes occurring in the context of multi-organ autoimmunity/inflammatory conditions such as connective tissue diseases (CTDs). In spite of significant associated morbidity and potential disability, ILD has yet to be linked to the ICF. Methods: Each instrument and their question-items within the consensus-recommended core sets for clinical trials in ILD were deconstructed to single concept units, and then linked per updated ICF linkage rules. Inter-linker agreement was established. Three additional subsequently validated measures were also included. Results: One-hundred-eleven ICF categories were identified for ten PROMs and three traditional objective measures that were amenable to ICF linkage. The proportion of agreement ranged from 0.79 (95% CI: 0.62, 0.91) to 0.93 (0.76, 0.99) with the overall proportion of inter-linker agreement being very high 0.86 (0.82, 0.89) for the initial instruments, with 94-100% for the three additional PROMs. Thirty-four new Personal Factors emerged to capture disease-specific qualities not elsewhere described in ICF, e.g. pf_embarrassed by cough or pf_panic/afraid when cant get a breath. Conclusion: This first known

BackgroundTwo phase 3 clinical trials showed that use of a monthly vaginal ring containing 25 mg dapivirine was well tolerated and reduced HIV-1 incidence in women by approximately 30% compared with placebo. We aimed to evaluate use and safety of the dapivirine vaginal ring (DVR) in open-label settings with high background rates of HIV-1 infection, an important step for future implementation.MethodsWe did a phase 3B open-label extension trial of the DVR (MTN-025/HIV Open-label Prevention Extension [HOPE]). Women who were HIV-1-negative and had participated in the MTN-020/ASPIRE phase 3 trial were offered 12 months of access to the DVR at 14 clinical research centres in Malawi, South Africa, Uganda, and Zimbabwe. At each visit (monthly for 3 months, then once every 3 months), women chose whether or not to accept the offer of the ring. Used, returned rings were tested for residual amounts of dapivirine as a surrogate marker for adherence. HIV-1 serological testing was done at each visit. Dapivirine amounts in returned rings and HIV-1 incidence were compared with data from the ASPIRE trial, and safety was assessed. This study is registered with ClinicalTrials.gov, NCT02858037.FindingsBetween July 16, 2016, and Oct 10, 2018, of 1756 women assessed for eligibility, 1456 were enrolled and participated in the study. Median age was 31 years (IQR 27-37). At baseline, 1342 (92·2%) women chose to take the DVR; ring acceptance was more than 79% at each visit up until 12 months and 936 (73·2%) of 1279 chose to take the ring at all visits. 12 530 (89·3%) of 14 034 returned rings had residual dapivirine amounts consistent with some use during the previous month (>0·9 mg released) and the mean dapivirine amount released was greater than in the ASPIRE trial (by 0·21 mg; p<0·0001). HIV-1 incidence was 2·7 per 100 person-years (95% CI 1·9-3·8, 35 infections), compared with an expected incidence of 4·4 per 100 person-years (3·2-5·8) among a population matched on age, site, and pr

In December 2013, the Public Services Managers charged the McKeldin Merged Desk Subgroup to assist with the planning for a single service point on the first floor of McKeldin Library. The group was to review the operations of the Circulation, Information and TLC Tech Desks and produce a report that included the following: - Recommendations for a service model at the 1st-floor service desk. - Develop complete schedules for all suggested models, as if we were implementing them. - Do we need a separate TLC? - What is the role of librarians at the desk(s)? - What are the training needs for staff at each desk (dependent on the service model recommended above)? The appendices section contains the charge. The report was due to Yelena Luckert, and Tim Hackman by Friday, March 28, 2014. The charge was revised in January 2014 to focus the report on the new desk scheduled for 2015/2016. Initially, the members of the group were to also look at the merged desk for the first floor after a redesign/construction on the Access Services Desk. It was decided that the Access Services Desk would not have a redesign or construction.

BackgroundAntiretroviral medications that are used as prophylaxis can prevent acquisition of human immunodeficiency virus type 1 (HIV-1) infection. However, in clinical trials among African women, the incidence of HIV-1 infection was not reduced, probably because of low adherence. Longer-acting methods of drug delivery, such as vaginal rings, may simplify use of antiretroviral medications and provide HIV-1 protection.MethodsWe conducted a phase 3, randomized, double-blind, placebo-controlled trial of a monthly vaginal ring containing dapivirine, a non-nucleoside HIV-1 reverse-transcriptase inhibitor, involving women between the ages of 18 and 45 years in Malawi, South Africa, Uganda, and Zimbabwe.ResultsAmong the 2629 women who were enrolled, 168 HIV-1 infections occurred: 71 in the dapivirine group and 97 in the placebo group (incidence, 3.3 and 4.5 per 100 person-years, respectively). The incidence of HIV-1 infection in the dapivirine group was lower by 27% (95% confidence interval [CI], 1 to 46; P=0.046) than that in the placebo group. In an analysis that excluded data from two sites that had reduced rates of retention and adherence, the incidence of HIV-1 infection in the dapivirine group was lower by 37% (95% CI, 12 to 56; P=0.007) than that in the placebo group. In a post hoc analysis, higher rates of HIV-1 protection were observed among women over the age of 21 years (56%; 95% CI, 31 to 71; P<0.001) but not among those 21 years of age or younger (-27%; 95% CI, -133 to 31; P=0.45), a difference that was correlated with reduced adherence. The rates of adverse medical events and antiretroviral resistance among women who acquired HIV-1 infection were similar in the two groups.ConclusionsA monthly vaginal ring containing dapivirine reduced the risk of HIV-1 infection among African women, with increased efficacy in subgroups with evidence of increased adherence. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01617096 .).

VOICE-a phase 2B, placebo-controlled, randomized trial testing daily use of an antiretroviral tablet (tenofovir or Truvada) or daily use of tenofovir gel in 5029 women from South Africa, Uganda, and Zimbabwe-found none of the drug regimens effective in reducing HIV-1 acquisition in the intent-to-treat analysis. More than half of women assigned to active products in a case cohort sample had no drug detected in any plasma specimens tested during the trial. Yet, in response to questions asked of participants during the trial, ≥90 % of doses were reportedly taken. To explore factors associated with low adherence, a behavioral termination visit questionnaire was developed after early closure of the oral tenofovir and vaginal gel arms. We hypothesized that participants would be more forthcoming about nonuse after they exited the trial than during monthly/quarterly follow-up visits. Comparison of adherence reporting at routine follow-up visits with reporting at trial termination, however, indicates that disclosure of product nonadherence did not increase at the termination visit as anticipated. In resource-limited settings where women value the ancillary benefits provided by trial participation and are concerned that disclosure of nonuse may jeopardize trial participation, objective measures of adherence may yield more meaningful data regarding the inability or reluctance to use than measures of product use derived from self-report.

BACKGROUND: Antiretroviral medications that are used as prophylaxis can prevent acquisition of human immunodeficiency virus type 1 (HIV-1) infection. However, in clinical trials among African women, the incidence of HIV-1 infection was not reduced, probably because of low adherence. Longer-acting methods of drug delivery, such as vaginal rings, may simplify use of antiretroviral medications and provide HIV-1 protection. METHODS: We conducted a phase 3, randomized, double-blind, placebo-controlled trial of a monthly vaginal ring containing dapivirine, a non-nucleoside HIV-1 reverse-transcriptase inhibitor, involving women between the ages of 18 and 45 years in Malawi, South Africa, Uganda, and Zimbabwe. RESULTS: Among the 2629 women who were enrolled, 168 HIV-1 infections occurred: 71 in the dapivirine group and 97 in the placebo group (incidence, 3.3 and 4.5 per 100 person-years, respectively). The incidence of HIV-1 infection in the dapivirine group was lower by 27% (95% confidence interval [CI], 1 to 46; P=0.046) than that in the placebo group. In an analysis that excluded data from two sites that had reduced rates of retention and adherence, the incidence of HIV-1 infection in the dapivirine group was lower by 37% (95% CI, 12 to 56; P=0.007) than that in the placebo group. In a post hoc analysis, higher rates of HIV-1 protection were observed among women over the age of 21 years (56%; 95% CI, 31 to 71; P<0.001) but not among those 21 years of age or younger (-27%; 95% CI, -133 to 31; P=0.45), a difference that was correlated with reduced adherence. The rates of adverse medical events and antiretroviral resistance among women who acquired HIV-1 infection were similar in the two groups. CONCLUSIONS: A monthly vaginal ring containing dapivirine reduced the risk of HIV-1 infection among African women, with increased efficacy in subgroups with evidence of increased adherence. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01617096 .).

Aim A Delphi survey was undertaken to refine the position description of a registered nurse working in a forensic hospital, in New South Wales, Australia. Background Prior to commencing operation in 2008, position descriptions were developed from a review of legislation, as well as policies and procedures used by existing forensic mental health services in Australia. With an established workforce and an evolving model of care, a review of the initial registered nurse position description was required. Method An online Delphi survey was undertaken. Eight executive (88.9%) and 12 (58.3%) senior nursing staff participated in the first survey round. A total of four survey rounds were completed. Results At the final round, there was consensus (70%) that the revised position description was either very or somewhat suitable. There were a total of nine statements, from 31 originally produced in round 1, that did not reach consensus. Conclusions The Delphi survey enabled a process for refining the Forensic Hospital registered nurse position description. Implications for nursing management Methods that facilitate executive and senior nursing staff consensus in the development and review of position descriptions should be considered in nursing management.

Aim A Delphi survey was undertaken to refine the position description of a registered nurse working in a forensic hospital, in New South Wales, Australia. Background Prior to commencing operation in 2008, position descriptions were developed from a review of legislation, as well as policies and procedures used by existing forensic mental health services in Australia. With an established workforce and an evolving model of care, a review of the initial registered nurse position description was required. Method An online Delphi survey was undertaken. Eight executive (88.9%) and 12 (58.3%) senior nursing staff participated in the first survey round. A total of four survey rounds were completed. Results At the final round, there was consensus (70%) that the revised position description was either very or somewhat suitable. There were a total of nine statements, from 31 originally produced in round 1, that did not reach consensus. Conclusions The Delphi survey enabled a process for refining the Forensic Hospital registered nurse position description. Implications for nursing management Methods that facilitate executive and senior nursing staff consensus in the development and review of position descriptions should be considered in nursing management.

Aim This study evaluated a framework for nursing managers which entailed supporting and challenging participants to critically analyse the effectiveness of their workplace behaviours in facilitated discussion groups using context-laden real-life scenarios. Background Leadership development in nursing managers has been shown to reduce burnout and promote workplace satisfaction. Method Ninety per cent of nursing managers (n = 63) employed in the organisation participated in the study. Data relating to burnout, workplace satisfaction and leadership practices were collected prior to and after participation in the support and challenge framework. Qualitative feedback was sought through a survey administered at follow-up. Result Nursing Unit Managers were significantly less satisfied in their intrinsic domain of workplace satisfaction at follow-up. Qualitative feedback indicated that participants experienced benefits related to networking, personal development and role development. Conclusion The experience of critiquing and challenging leadership when shared with peers who practice in a similar context was qualitatively reported as beneficial and valuable, in spite of a decrease in workplace satisfaction. Implications for nursing management Nursing manager's leadership development is a continuous process. Supporting and challenging nursing managers is likely to generate uncertainty related to self and role. The sharing and testing of this uncertainty with peers is welcomed and warrants further exploration.

Leadership is a highly prized commodity across a range of contemporary industries, and healthcare is no exception where the stakes are high. Healthcare, previously viewed as peripheral to many other societal structures, is now front and center, largely due to increasing costs and the increased consumption of gross domestic product. Australia is a culturally diverse and pluralistic society supporting a system of universal healthcare that is accountable and transparent. There are over 200,000 nurses in Australia, working in hospitals, clinics, aged care facilities, and schools, and these individuals are integrally important to the effective and functional health system. Moreover, Australia is intensely aware of the effects of globalization and the importance of a global strategy for human resources for health.

Aim This study evaluated a framework for nursing managers which entailed supporting and challenging participants to critically analyse the effectiveness of their workplace behaviours in facilitated discussion groups using context-laden real-life scenarios. Background Leadership development in nursing managers has been shown to reduce burnout and promote workplace satisfaction. Method Ninety per cent of nursing managers (n = 63) employed in the organisation participated in the study. Data relating to burnout, workplace satisfaction and leadership practices were collected prior to and after participation in the support and challenge framework. Qualitative feedback was sought through a survey administered at follow-up. Result Nursing Unit Managers were significantly less satisfied in their intrinsic domain of workplace satisfaction at follow-up. Qualitative feedback indicated that participants experienced benefits related to networking, personal development and role development. Conclusion The experience of critiquing and challenging leadership when shared with peers who practice in a similar context was qualitatively reported as beneficial and valuable, in spite of a decrease in workplace satisfaction. Implications for nursing management Nursing manager's leadership development is a continuous process. Supporting and challenging nursing managers is likely to generate uncertainty related to self and role. The sharing and testing of this uncertainty with peers is welcomed and warrants further exploration.

Leadership is a highly prized commodity across a range of contemporary industries, and healthcare is no exception where the stakes are high. Healthcare, previously viewed as peripheral to many other societal structures, is now front and center, largely due to increasing costs and the increased consumption of gross domestic product. Australia is a culturally diverse and pluralistic society supporting a system of universal healthcare that is accountable and transparent. There are over 200,000 nurses in Australia, working in hospitals, clinics, aged care facilities, and schools, and these individuals are integrally important to the effective and functional health system. Moreover, Australia is intensely aware of the effects of globalization and the importance of a global strategy for human resources for health.

Higher education institutions are undergoing a fundamental transformation in their role in our society, economic structure, and value system. The University of Maryland (UMD) Libraries find themselves in the midst of this constantly changing environment where new technologies, new pedagogies, new publishing models, and new environments evolve every day. Librarians are being challenged to undertake new roles in order to support the research activities of their user population and to foster research and teaching initiatives across the university. With these trends in mind, the Research Commons Task Force was charged to research and plan for implementing new services and creating new research spaces. To accomplish this task, the Research Commons Task Force consulted the literature and conducted an extensive environmental scan by interviewing those involved in the creation of research commons at other universities, meeting with internal partners, and surveying graduate students and faculty at the University of Maryland. The resulted Final Report is a comprehensive document, which addresses UMD research needs, assessment, staffing, spaces, and technology concerns. It intends to serve as a guide for developing and implementing this model at the UMD Libraries and provides a robust yet flexible framework for the future.

This project entails content analysis of 200 websites for authors commonly taught in university-level American literature survey courses. Using a faceted classification scheme to categorize site content, the researchers explore the extent to which consistency has developed in the scope and content of Web sites for authors in the canon of American literature. The goal is to identify both the full range of unique content on these Web sites and, within that range, the core content elements that comprise the “American Author Web Site” genre. The authors also gathered biographical details on each author, to consider the question of whether Web site content varies by an author’s gender or racial background. Ultimately, the goal is to identify a set of common and/or “best” practices for content and organization of author Web sites that will assist both undergraduate students and advanced researchers looking for author information on the Web, as well as site designers hoping to create quality resources for these users. In the choice of subject, size of the sample, and novelty of the approach, this promises to be a unique project that will interest librarians, web developers, and literature researchers alike.

We describe the issues associated with the calibration and validation of ocean satellite sensors and systems operating the VIIRS--Vis/IR Imager Radiometer Suite, which is designed as part of the National Polar-orbiting Operational Environmental Satellite System (NPOESS). Our objective is to develop a coordinated, integrated calibration/validation plan for Navy ocean satellite products, including the development of standard protocols and procedures to compare satellite retrievals with ground-truth measurements. We outline the measurements required, the collection and analysis protocols for the satellite and in situ data, satellite signal-to-noise constraints for ocean applications, and other important issues that must be addressed to reach the desired levels of accuracy. By building on our existing capabilities and a transition framework that is already in place between the Naval Research Laboratory Stennis Space Center (NRL-SSC) and the Naval Oceanographic Office (NAVOCEANO), we can develop and implement a plan now, using existing systems, in preparation for future systems. This approach will ensure that Navy-wide standard and consistency levels will be achieved for all ocean products across all platforms., The original document contains color images.

The first day of school is always filled with great anticipation. You're enrolled in what some architects have called the most beautiful high school in America. As you make your way toward Central High School in Little Rock, Arkansas, you become aware of an angry mob that has gathered across the street from the high school. In fact, the governor has called out the National Guard to maintain order, but every time you attempt to enter the school the guardsmen block your way. This is the scene that greeted "the Little Rock Nine," as they were called by the media, in September 1957. Central High School in Little Rock, Arkansas, was the first important test for the implementation of the U.S. Supreme Court's historic Brown v. Board of Education of Topeka decision of May 17, 1954. The Little Rock controversy was the first test of the national resolve to enforce equality in public school education in the face of massive Southern defiance during the period following the Brown decision. Many individuals and organizations in and around the city took up the cause for civil rights, such as Mrs. Daisy Bates, who helped the students gain access to the high school. On May 27, 1958, Ernest Green (one of the "Little Rock nine") became the first African-American to graduate from Central High School. Central High School National Historic Site commemorates the events that surrounded the crisis of 1957. It has been 50 years since the desegregation of Central High School. Join the rangers and other special guests of this national historic site to examine the issues and compelling stories that have evolved from the desegregation of Little Rock Central High School., An electronic field trip from Little Rock Central High School National Historic Site., This archival material has been provided for educational purposes. Ball State University Libraries recognizes that some historic items may include offensive content. Our statement regarding objectionable content is available at: https://dmr.bsu.edu/digital/about

Health and consumerism is a partnership featured in many Western developed countries. Nearly a decade ago, the National Quality Taskforce and Advisory Council recommended the adoption of a consumer oriented approach as being fundamental to providing safer services, minimising preventable adverse health outcomes, whist also improving healthcare quality. In accordance with this recommendation, it is now commonplace for healthcare organisations to incorporate the consumer oriented philosophy into their mission statements. In addition, healthcare recipients tend to be referred to as consumers in preference to the traditional term patient. Despite organisational commitment for change and reports of consumer satisfaction with acute care services in Australia (AIHW 2000), the findings from the Bristol Inquiry (2001) and the King Edward Memorial Hospital Inquiry (2001) suggests that there is an absence of consensus as to the impact of these initiatives on the delivery or quality of frontline healthcare. This study aims to determine indicators of consumer participation in the planning and delivery of healthcare in an Australian context. The practice of consumer participation at the individual level of frontline healthcare is examined specifically for indicators of active participation in both decision making and information sharing. This study is complimentary to Phase Two of a Commonwealth funded project designed to explore clinical teams and the organisation of care related to the clinical condition, elective caesarean section. The study’s participants have been determined by the Commonwealth project, with the study’s samples being drawn from the recipients and providers of elective caesarean section healthcare, in three Queensland public hospitals over a three month time frame. A multi-method approach is utilised to navigate the complex social and professional constructs that impact on the organisation and recording of elective caesarean section healthcare. Triangulation

Health and consumerism is a partnership featured in many Western developed countries. Nearly a decade ago, the National Quality Taskforce and Advisory Council recommended the adoption of a consumer oriented approach as being fundamental to providing safer services, minimising preventable adverse health outcomes, whist also improving healthcare quality. In accordance with this recommendation, it is now commonplace for healthcare organisations to incorporate the consumer oriented philosophy into their mission statements. In addition, healthcare recipients tend to be referred to as consumers in preference to the traditional term patient. Despite organisational commitment for change and reports of consumer satisfaction with acute care services in Australia (AIHW 2000), the findings from the Bristol Inquiry (2001) and the King Edward Memorial Hospital Inquiry (2001) suggests that there is an absence of consensus as to the impact of these initiatives on the delivery or quality of frontline healthcare. This study aims to determine indicators of consumer participation in the planning and delivery of healthcare in an Australian context. The practice of consumer participation at the individual level of frontline healthcare is examined specifically for indicators of active participation in both decision making and information sharing. This study is complimentary to Phase Two of a Commonwealth funded project designed to explore clinical teams and the organisation of care related to the clinical condition, elective caesarean section. The study’s participants have been determined by the Commonwealth project, with the study’s samples being drawn from the recipients and providers of elective caesarean section healthcare, in three Queensland public hospitals over a three month time frame. A multi-method approach is utilised to navigate the complex social and professional constructs that impact on the organisation and recording of elective caesarean section healthcare. Triangulation

Health and consumerism is a partnership featured in many Western developed countries. Nearly a decade ago, the National Quality Taskforce and Advisory Council recommended the adoption of a consumer oriented approach as being fundamental to providing safer services, minimising preventable adverse health outcomes, whist also improving healthcare quality. In accordance with this recommendation, it is now commonplace for healthcare organisations to incorporate the consumer oriented philosophy into their mission statements. In addition, healthcare recipients tend to be referred to as consumers in preference to the traditional term patient. Despite organisational commitment for change and reports of consumer satisfaction with acute care services in Australia (AIHW 2000), the findings from the Bristol Inquiry (2001) and the King Edward Memorial Hospital Inquiry (2001) suggests that there is an absence of consensus as to the impact of these initiatives on the delivery or quality of frontline healthcare. This study aims to determine indicators of consumer participation in the planning and delivery of healthcare in an Australian context. The practice of consumer participation at the individual level of frontline healthcare is examined specifically for indicators of active participation in both decision making and information sharing. This study is complimentary to Phase Two of a Commonwealth funded project designed to explore clinical teams and the organisation of care related to the clinical condition, elective caesarean section. The study’s participants have been determined by the Commonwealth project, with the study’s samples being drawn from the recipients and providers of elective caesarean section healthcare, in three Queensland public hospitals over a three month time frame. A multi-method approach is utilised to navigate the complex social and professional constructs that impact on the organisation and recording of elective caesarean section healthcare. Triangulation

Since the 1970s Integrated Pest Management (IPM) has been promoted as an alternative to the singular reliance on pesticides to control agricultural pests. IPM involves the combination of chemical and non-chemical pest management practices to minimize pest damage to crops and reduce overall pesticide use. Although IPM has been promoted in both industrialized and Third World countries to reduce environmental and human health problems associated with pesticide use, it has not been widely adopted, particularly among small-scale farmers in the Third World. An important technical constraint to the adoption of IPM is the lack of simple, effective IPM techniques that farmers can easily incorporate into their existing farming systems. However, numerous non-technical constraints discourage farmers from adopting those IPM practices that have already been shown to be effective. Non-technical constraints to the adoption of IPM are the external political-economic forces and location-specific environmental, social and economic factors that may create obstacles to the adoption of IPM practices at the farm level. This thesis will use a political ecology approach to identify and examine the non-technical constraints to the adoption of IPM in the community of Denbigh Kraal in Jamaica.

Since the 1970s Integrated Pest Management (IPM) has been promoted as an alternative to the singular reliance on pesticides to control agricultural pests. IPM involves the combination of chemical and non-chemical pest management practices to minimize pest damage to crops and reduce overall pesticide use. Although IPM has been promoted in both industrialized and Third World countries to reduce environmental and human health problems associated with pesticide use, it has not been widely adopted, particularly among small-scale farmers in the Third World. An important technical constraint to the adoption of IPM is the lack of simple, effective IPM techniques that farmers can easily incorporate into their existing farming systems. However, numerous non-technical constraints discourage farmers from adopting those IPM practices that have already been shown to be effective. Non-technical constraints to the adoption of IPM are the external political-economic forces and location-specific environmental, social and economic factors that may create obstacles to the adoption of IPM practices at the farm level. This thesis will use a political ecology approach to identify and examine the non-technical constraints to the adoption of IPM in the community of Denbigh Kraal in Jamaica.