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Background: Individuals living in communities with poor access to healthcare may be unaware of their high blood pressure (BP). While the use of community health workers (CHWs) can address gaps in human resources for health, CHWs in Uganda have not been used previously for BP screening and management. We report the results of an initiative to train CHWs to evaluate BP and to administer group-based education in Kalangala and Buvuma Island Districts of Lake Victoria, Uganda. Methods: We randomly selected 42 of 212 villages. We trained 84 CHWs based in island districts on measuring BP. CHWs visited all households in the selected villages and invited all adults ≥18 years to be screened for high BP. We used the World Health Organization’s STEPwise tool to collect data on demographic and behavioral characteristics and BPmeasurements. High blood pressure was defined as systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mm Hg over three readings. CHWs created and led fortnight support groups for individuals identified with high blood pressure at baseline. At each group meeting, CHWs re-measured BP and administered an intervention package, which included self-management and lifestyle education to participants. The paired t-test was used to compare mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after the intervention. Generalized estimating equations (GEE) were used to model longitudinal changes in BP. Results: We trained 84 CHWs to measure BP and deliver the intervention package. Among 2,016 community members, 570 (28.3%) had high blood pressure; of these, 63 (11.1%) had a previous diagnosis of hypertension. The comparison of SBP and DBP before and after the intervention revealed significant reductions in mean SBP from 158mmHg (SD=29.8) to 149 mmHg (SD=29.8) (pConclusion: High BP was common but previously undiagnosed. The CHW-led group-based self-management and education for controlling high BP was effective in the island districts in Uganda. Scaling up the intervention in other hard-to-reach districts could improve control of high BP on a large scale.

There are two parts to this article. The first is a general overview of how hearing aid classification works, including a comparison study of normal-hearing listeners and multiple manufacturers' hearing aids while listening to a sound parkour composed of a multitude of acoustic scenes. Most hearing aids applied nearly identical classification for simple listening environments. But differences began to appear across manufacturers' products when the listening environments became more complex. The second section reviews the results of a study of the acoustic ecology (listening environments) experienced by several cohorts of hearing aid users over a 4-month period. The percentages of time people spent in seven different listening environments were mapped. It was learned that they spent an average of 57% of their time in conversation and that age is not a good predictor of the amount of time spent in most listening environments. This is because, when grouped by age, there was little to no difference in the distribution of time spent in the seven listening environments, whereas there was tremendous variability within each age group.

Sandbars and islands provide important nesting and foraging habitat for birds (including listed species) and shallow water habitat for many aquatic species in riverine ecosystems. In-stream habitat is especially important in incised channels lacking floodplain connectivity, with channel bars providing important riparian habitat. However, some river management practices significantly alter and sometime eventually eliminate these important habitats. Several US Army Corps of Engineers districts are planning or actively building instream bars and islands using flow management and/or instream structures. Sister agencies (e.g., US Bureau of Reclamation) have similar initiatives downstream of their reservoir structures. This report outlines considerations for establishing and managing sandbar and island features. It presents a compilation of proven techniques for promoting sandbar and island development and for reducing erosion of these features.

Stroke is the fifth leading cause of death in the United States (1). In 2017, on average, a stroke-related death occurred every 3 minutes and 35 seconds in the United States, and stroke is a leading cause of long-term disability (1). To prevent mortality or long-term disability, strokes require rapid recognition and early medical intervention (2,3). Common stroke signs and symptoms include sudden numbness or weakness of the face, arm, or leg, especially on one side; sudden confusion or trouble speaking; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, or loss of balance; and a sudden severe headache with no known cause. Recommended action at the first sign of a suspected stroke is to quickly request emergency services (i.e., calling 9-1-1) (2). Public education campaigns have emphasized recognizing stroke signs and symptoms and the importance of calling 9-1-1, and stroke knowledge increased 14.7 percentage points from 2009 to 2014 (4). However, disparities in stroke awareness have been reported (4,5). Knowledge of the five signs and symptoms of stroke and the immediate need to call emergency medical services (9-1-1), collectively referred to as "recommended stroke knowledge," was assessed among 26,076 adults aged ≥20 years as part of the 2017 National Health Interview Survey (NHIS). The prevalence of recommended stroke knowledge among U.S. adults was 67.5%. Stroke knowledge differed significantly by race and Hispanic origin (p

Objective The objective of the study was to determine whether short-term experience (i.e., 4 weeks) with a smartphone-based hearing aid application (SHAA) might positively improve attitudes toward amplification uptake and hearing impairment. Method We recruited 15 experienced hearing aid wearers who had ceased wearing their devices for > 1 year (i.e., “In-the-Drawer” group) and 15 individuals with self-reported hearing difficulties who had yet to adopt hearing aids (i.e., “First-Time” group). We obtained participant attitudes pre- and post-SHAA using 3 surveys and analyzed perceptible changes in attitude for each survey. Comparative findings were then generalized to the health belief model in the context of perceived benefits (i.e., efficacy of an action to reduce risk) and reduced perceived barriers (i.e., tangible and psychological costs that inhibit compliance and adoption). Results A short trial period with an SHAA appears to modify the psychological perception toward amplification and reduce listener perception with respect to hearing difficulties in both groups. Conclusion A short trial period with an SHAA improved the perceived benefits and reduced the perceived barriers in the average First-Time listener, who often delays adoption of traditional amplification. The same trial period was also found to improve perceived benefits and reduce perceived barriers for the average In-the-Drawer listener, but to a lesser degree than their First-Time counterparts.

Dredging efficacy in reducing polychlorinated biphenyl (PCB) sediment contamination in the Lower Fox River, Wisconsin, was assessed by comparing predredging and postdredging concentration ...

Erosion along shorelines is a major cause in the conversion of shoreline wetlands to open water bodies. Conventional shoreline protection structures are expensive to construct and may impede environmental exchanges essential for connectivity and functionality. A novel marsh shoreline protection technology, the Wave Suppressor and Sediment Collection (WSSC) system, addresses these issues. Laboratory studies were conducted on three WSSC units to determine the governing parameters of sediment collection efficiency of this technology. The three units had varying open areas and pipe sizes which enabled those parameters to be directly compared. Two types of sands with median particle diameters (d50) of 0.43 and 0.34 mm were used to evaluate the effects of particle size on the collection efficiency of the units. A new mathematical model was developed to predict the sediment collection efficiency using Van Rijn’s equation for particle fall velocity, and Ribberink and Al-Salem’s equation for sand concentration distribution in a water column. Results showed that the Unit 1, Unit 2 and Unit 3 are capable of collecting sand at 0.30, 0.21 and 0.21 (kg/h) for sand 1, and at 0.39, 0.29, 0.39 (kg/h) for sand 2 respectively. The mathematical model fit the experimental data well and from the model, mass accumulation coefficient (α) alpha was calculated. Mass accumulation coefficients (α) for sand 1 and sand 2 were- 0.94 and 0.97 for Unit 1, 0.63 and 0.70 for Unit 2 and 0.32 and 0.22 for Unit 3 respectively. A sensitivity study of the mathematical model was also performed to determine the governing factors behind the sand collection. The sensitivity study found that water depth, wave height and particle diameter affected the sand collection efficiency the most. The amount of open area on the units, frequency and wavelength were also found to have some effect on collection efficiency.

Minimizing coastal wetland loss is a high priority in coastal areas worldwide. Typical shoreline protection consists of hard structures placed near areas affected by wave action. These commonly used protection methods are costly, and may have negative impacts on the surrounding areas. The Wave Suppression and Sediment Collection (WSSC) system, made of multiple Wave Robber® units, is an alternative shoreline protection structure. The primary goal of this study is to determine the performance characteristics of the technology in terms of energy coefficients. Experiments were performed on three scaled units within a laboratory wave tank. Performance characterization showed that the units have wave energy reflections of 0.47–0.83, transmission ranging from 0.10 to 0.42, and wave energy dissipation between 0.49 and 0.88, depending upon unit geometry and wave conditions. Performance data were also compared to other studies on shoreline protection structures. WSSC units reflect more wave energy and transmit less energy compared to other breakwater systems. These units could be utilized in coastal marshes with a large fetch, to reduce wave-induced erosion.

Differences in contraceptive method use have been noted among women of different races, but studies describing contraceptive method use among Native Hawaiian women have not been published. To examine method choice in this group, the authors conducted a database review of the Hawai‘i State Department of Health Title X program. Reviewed were client visit records (CVRs) that health care providers completed for women who were ages 15–44 years, avoiding pregnancy, not currently pregnant, and using a contraceptive method (N=54 513). Because a patient could have had several visits during the study period, the contraceptive method chosen at the last visit was selected for analysis. Statistical analyses included descriptive statistics, bivariate analyses, and logistic regression. The proportion of Native Hawaiian women who selected a highly-effective method of contraception (HEC), defined as an intrauterine device, implant, or permanent contraception, was higher than the proportion of non-Native Hawaiian women who selected an HEC. Overall, 15.4% of Native Hawaiian women during the study period chose HEC, compared to 8.8% of non-Native Hawaiian women. In a logistic regression analysis, Native Hawaiian women ages 15–29 were 1.46 times more likely to use HEC (95% CI: 1.35–1.58) than non-Native Hawaiian women ages 15–29, and Native Hawaiian women ages 30–44 were 1.69 times more likely to use HEC (95% CI: 1.53–1.87) than non-Native Hawaiian women in the same age group. Because Native Hawaiian women are reported to have higher rates of unintended pregnancy in the state compared to other racial groups, additional research exploring contraceptive non-use and pregnancy intention are needed.

Shoreline erosion along open water bodies and waterways is a major cause in the conversion of wetlands and uplands to open water habitat. Conventional shoreline protective structures are expensive to construct in these environments, and may impede environmental exchanges essential for connectivity and functionality. The structure, Wave Suppression and Sediment Collection (WSSC) System that contains multiple Wave Robber™ units, is an alternative for shoreline protection that maintains environmental connectivity. The primary goals of this study are to evaluate the wave reduction and sediment collection performance of the unit as well as optimize its design. This study showed that the unit reduces 84 to 90% of the wave energy while collecting and retaining fine-grained sediment. A mathematical model fits the sediment collection data reasonably well with average correlation coefficients of about 0.87. Modeling results show that the sediment collection efficiency of the unit for fine-grained sediment is about 14%. Total area of flow through the unit was determined to be more important than the area distributed among the number and size of pipes. The sensitivity study shows that wave height and initial concentration are the most important factors effecting sediment collection.

This article has been requested because Juvenile Judges are interested in the idea of Court Clinic services. They have their own ideas about their needs for such service, and how they would be served, Further, they would be interested in knowing how such a service can be established, how it must be implemented, what it is really like to have the service, and how the service should feel about the Court.

Purpose: Hawaii has the lowest rate of community water fluoridation in the nation, resulting in poor oral health for children statewide. It thus falls to healthcare providers that see children to remedy this by prescribing fluoride supplements as per American Dental Association schedules and guiding parents in their daily usage. However, knowledge of actual practice and adherence on both provider and patient sides has never been studied. Thus, the purpose …

There are significant shortages in the public health workforce and it's expected to worsen. Efforts to reduce this shortage are varied and include building the workforce by increasing exposure of students and young professionals in applied public health experiences. Providing these experiences increases productivity, and may help alleviate some of the workforce shortages in public health. This article seeks to highlight the work done at the Family Health Services Division (FHSD) in the Hawai‘i Department of Health over the past 6 and half years in working with students in epidemiology practicum and fellowship experiences.

Record linkage deals with finding records that identify the same real world entity, such as an individual or a business, from a given file or set of files. Record linkage problem is also referred to as the entity resolution or record recognition problem. To locate those records identifying the same real world entity, in principle, pairwise record analyses have to be performed among all records. Analytical operations between two records vary from comparing corresponding fields to enhancing records through large knowledge bases and querying large databases. Hence, these operations are complex and take time. To reduce the number of pairwise record comparisons, blocking techniques are introduced to partition the records into blocks. After that records in each block are analyzed against one and another. One of the effective blocking methods is the closure approach, where a “related” equivalence relation is used to partition the records into equivalence classes. This paper introduces the closure problem and describes the design and implementation of a parallel and distributed closure prototype system running in an enterprise grid.

The authors investigated the effects of hand function and aging on the ability to manipulate different hearing instrument controls. Over the past quarter century, hearing aids and hearing aid controls have become increasingly miniaturized. It is important to investigate the aging hand and hearing aid ergonomics because most hearing aid wearers are adults aged 65 years and above, who may have difficulty handling these devices.In Experiment 1, the effect of age on the ability to manipulate two different open-fit behind-the-ear style hearing aids was investigated by comparing the performance of 20 younger (18-25 years of age), 20 young-old (60-70 years of age), and 20 older adults (71-80 years of age). In Experiment 2, ability to manipulate 11 different hearing instrument controls was investigated in 28 older adults who self-reported having arthritis in their hand, wrist, or finger and 28 older adults who did not report arthritis. For both experiments, the relationship between performance on the measures of ability to manipulate the devices and performance on a battery of tests to assess hand function was investigated.In Experiment 1, age-related differences in performance were observed in all the tasks assessing hand function and in the tasks assessing ability to manipulate a hearing aid. In Experiment 2, although minimal differences were observed between the two groups, significant differences were observed depending on the type of hearing instrument control. Performance on several of the objective tests of hand function was associated with the ability to manipulate hearing instruments.The overall pattern of findings suggest that haptic (touch) sensitivity in the fingertips and manual dexterity, as well as disability, pain, and joint stiffness of the hand, all contribute to the successful operation of a hearing instrument. However, although aging is associated with declining hand function and co-occurring declines in ability to manipulate a hearing instrument, for the sample of individuals in this study, including those who self-reported having arthritis, only minimal declines were observed.

The acoustic effect of four resonators on the output of a single hearing aid was measured on ten subjects. The purpose was to compare the effect of each of the resonators in a 2 cc (2 cm3) coupler and in real ears. Two of the resonators were special earhook resonators and the other two were contained in the earmolds. The output of the hearing aid with a standard earhook-earmold configuration was compared to the output of the hearing aid through each of four earmold-earhook configurations. One resonator was present in each of the nonstandard systems. Each of the four comparisons was made in (1) the real ears using a probe microphone in a sound-treated test booth and (2) in the coupler with the hearing aid placed in a sound-treated test box. Predictable, systematic differences were found between the 2 cc coupler measurements and the real-ear measurements. Therefore, a reliable transfer function for each resonator can be expected when 2 cc coupler specifications are used to fit resonators for specific hearing losses.

In a recent survey of audiologists [Martin et al., J. Am. Acad. Aud. 9, 95–100 (1998)] the authors reported that only 24% of respondents used insert earphones in any capacity. Surprisingly few clinicians use insert earphones even though they have several desirable qualities relative to supra‐aural headphones. Insert earphones are reputed to eliminate ear canal collapse, reduce occlusion, and increase interaural attenuation. The purpose of this study was to determine the extent to which insert earphones might increase the speed and ease with which hearing tests are obtained. Audiometric assessments were obtained on 91 individuals in the course of their standard clinical investigations. ER‐3A insert earphones were used to assess 46 of them and the other 45 were tested using TDH‐39 supra‐aural headphones. The audiometric tests of the two groups were compared on the basis of: testing time, earphone‐related occlusion effects, necessity for masking the nontest ear, collapsed ear canals, and occluded or collapsed insert earphones. The insert earphones were found to be superior in every category. It is strongly recommended that ER‐3A insert earphones should become the earphones of choice for audiometric assessment.

VioLit summary: OBJECTIVE: The purpose of this article by Russell was to describe some of the basic elements common to juvenile murderers, with the intent of better understanding their character structures and the circumstances leading to their violence. METHODOLOGY: The author employed a non-experimental design by describing the characteristics of 24 juvenile males who had committed murder and were then tracked and studied by the author for 15 years. Their ages at the time of the initial investigation ranged from 14 to 17, most had killed people they knew, 13 were diagnosed as neurotic, 3 as antisocial, 5 as schizoid, 2 as severely narcissistic, and 2 as psychotic. FINDINGS/DISCUSSION: In at least 19 of these cases the author identified a common set of characteristics and a similar sequence of events which led to their violence: 1) A lack of socialization based on an unhealthy maternal relationship of strong ambivalence. The development in adolescence was therefore marked by severe unresolved conflicts over aggression and passivity. 2) A struggle for identity and self-expression, against strong regressive forces. 3) An intensification of this struggle through the mother's ongoing and relentless control, combined with a lack of support from the father. 4) An escalation of conflict and provocation which could not be countered by the minimal coping skills developed in such a stagnating environment. Immersed in complete self-involvement, the boys attempted to attribute their unacceptable feelings to someone else. 6) Finally, the development of a hostile fixation on the mother or another close figure, combined with increased paranoia, until the build-up became a break-through of the paranoid projection; at this point the murderous impulses resulted in acts that appeared justifiable to the boys. The author described 5 cases of the 19 to demonstrate his point. In each of these cases the ambivalent and controlling relationships of the mothers was very apparent, indicating that the boys had been pushed into dependent and submissive positions in relation to life in general, as well as in relation to their mothers. The confused sense of self which emerged from these circumstances led to great difficulty relating to other people, and ultimately to the final paranoid, self-justified recourse. In a few of the cases the author noted that although warning signs were made fairly clear through prior psychiatric evaluation, the families chose to disregard these warnings. However, the majority did not demonstrate obvious warnings as they continued to repress their inner turmoil and displayed an exterior of compliancy. This made diagnosis of the problem extremely difficult and denial among the families fairly easy. AUTHOR'S RECOMMENDATIONS: Because the closed, covert and highly protected relationships between these mothers and their sons made diagnosis extremely difficult, the author recommended a continued evaluation of the warning signs in such cases that they might be more effectively diagnosed. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) KW - Juvenile Homicide KW - Juvenile Offender KW - Juvenile Violence KW - Homicide Causes KW - Homicide Offender KW - Offender Characteristics KW - Violence Causes KW - Juvenile Development KW - Youth Development Language: en

(1977). Effects of Intraoral Mouth Guards on Ventilation. The Physician and Sportsmedicine: Vol. 5, No. 1, pp. 61-66.