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Migrations and refugees are a global phenomenon. People migrate from their country or region for many reasons, including to seek out economic opportunities, or to escape from atrocities or disasters. These migrants and refugees face various challenges at the destination countries due to language barriers, cultural differences, and social acceptance. The NGO Committee on Migration (CoM) has been established to form a coalition of organizations worldwide that advocate, educate, and collaborate to encourage the promotion and protection of migrants and their human rights, in accordance with the United Nations Charter. The NGOs operate in different parts of the world, and the information on their migrant trends and support activities are to be shared for better coordination and collaborative governance or for identifying high priority policy issues. This paper presents the visual analytics approach to support the NGOs around the globe to better understand and govern the NGO activities and migration trends, and to monitor international migration policy issues.

Objective Transition to adult IBD care continues to be a challenge. Efficacious models of improving transition to adult care in the United States are lacking. We present data from a pilot, prospective, non-randomized, intervention implemented at IBD centers in the Midwest and Southeast United States. Design and Methods Adolescents and young adults (AYAs; 16–20 years) with IBD and their parents completed a 4- to 5-month transition program (1 in-person group session; 4 individual telehealth sessions). Primary outcomes were feasibility (i.e., recruitment, retention, fidelity) and acceptability (i.e., program satisfaction). Secondary outcomes were changes in transition readiness, self-management skill acquisition, perceived readiness to transfer to adult care, and disease knowledge. Results The study exceeded goals for recruitment (target N = 20; actual: 36) and retention (target: 80%; actual: 86.11%). On average, it took participants 20.91 ± 3.15 weeks to complete our 4- to 5-month intervention and there were no deviations from the study protocol. Participant ratings for overall program satisfaction, perceived helpfulness, and program length and format were positive. Increases in transition readiness, t(30) = 8.30, d = 1.49, p < .001, self-management skill acquisition, t(30) = 3.93, d = 0.70, p < .001, and disease knowledge, t(30) = 8.20, d = 1.58, p < .001 were noted. AYA- and parent-perceived transfer readiness also improved (p’s < .05; d’s = 0.76–1.68). Conclusions This article presents feasibility and acceptability data for a 4- to 5-month transition intervention. Improvements in AYA transition readiness, self-management skill acquisition, IBD knowledge, and AYA/parent perceived transfer readiness were also observed.

Deficits in the preparation of patients with inflammatory bowel disease (IBD) who are transitioning to adult care are known yet studies presenting outcome data of transition interventions in IBD are lacking. We present data evaluating the impact of a transition coordinator on behavioral and clinical transition outcomes.A retrospective chart review identified 135 patients who had met with our transition coordinator and completed the Transition Readiness Assessment Questionnaire before, and 1 year after, the intervention. Changes in transition readiness, self-management skill acquisition, and clinical outcomes (eg, number of patients transferred vs "bounced back" to pediatrics, percentage of patients over age 21, changes in disease remission) were examined and compared with patients who received no intervention.Intervention participants demonstrated a significant increase in transition readiness, F(1, 134) = 24.34, P 0.001, and self-management skill acquisition, F(1, 134) = 5.61, P 0.05. The percentage of patients in remission significantly increased from pre- to post-intervention, χ(134) = 9.03, P 0.01. There were no significant changes in the comparison population (Ps 0.05). Following implementation of our programming, the percentage of patients over age 21 decreased by 33.07%.A 1-time transition coordinator-led intervention improved adolescent transition readiness and acquisition of self-management skills. The proportion of young adult patients retained in pediatric care was reduced. Benefits of hiring a transition coordinator are discussed.

Background Hepatitis B infection is a significant public health challenge despite improvements in vaccination efforts. Patients such as those on chronic immunosuppressive therapy for inflammatory bowel disease (IBD) or rheumatic disease may incur greater risk. The risk of reactivation of hepatitis B while on immunosuppressive therapy may have mortality rates up to 25%. These patients should be screened for acute or chronic infection and vaccinated if necessary. Our aim was to reliably complete hepatitis B screenings in patients receiving infliximab at Cincinnati Children’s Hospital Medical Center (CCHMC). Methods Eligible patients included all patients with gastroenterology (GI) IBD and rheumatology receiving infliximab between October 2015 and March 2016. Using quality improvement methodology and the ‘plan–do–study–act’ (PDSA) approach, interventions centred around education of clinical providers, previsit planning and the development of ‘talking points’ for patients. Results An initial screen of the IBD population revealed that 48% of the IBD patient population had been screened for anti-HBs alone, but no patients from GI or rheumatology divisions had a complete set of hepatitis B serology prior to the intervention including anti-Hep B Core and Hep B Surface Antigen. Seven PDSA cycles were performed during the 32-week intervention period, resulting in an increase in patients screened from 0% to ~85%. By March 2016, a total of 251 patients (201 GI, 50 rheumatology) had up-to-date hepatitis B serology screening. Automated ordering of the hepatitis B serology and ‘talking points’ for the provider had the greatest impact on successful screening. Conclusions We developed a method to obtain hepatitis B serology on at-risk patients on infliximab within two subspecialty divisions within a large children’s hospital. Next steps will be to develop a process to reliably provide vaccines for patients who are seronegative, expand this process to all patients who are identified as immunocompromised within GI and rheumatology and then expand this process to other divisions at the CCHMC.

Background Previsit planning (PVP) has been an integral part of clinical care for paediatric patients with inflammatory bowel disease (IBD) at Cincinnati Children’s Hospital Medical Center since 2007. Over the past years, we have adopted several programmes to improve health maintenance supervision for our paediatric patients with IBD but did not have a sustainable way to provide health maintenance updates for every patient at every encounter that was concise and complete in the setting of an increasing patient population and fewer support staff to complete the work. Methods Using quality improvement methods, we completed several Plan-Do-Study-Act (PDSA) cycles aimed at improving our centre’s ability to provide complete health maintenance ‘bundle’ recommendations from 0% to 90% of patients over a period of 11 months. Results First steps included consensus gathering and summarising evidence into guidelines suitable for the group. PDSAs centred on consensus building from standardised guidelines, using empty checklists for simulated and real patients, and use of autofilled checklists. After several PDSA cycles, we have improved our ability to provide complete health maintenance PVP from 0% to nearly 100% with very little variation. Conclusion Using the health maintenance PVP process, we can now sustainably provide health maintenance guidance for all outpatient clinic visits. We have begun to scale up this work and anticipate over the coming months that we will be able to expand the health maintenance PVP to provide complete PVP for over 90% of patients for any scheduled encounter including biologic infusion visits. We anticipate that using this reliable process we can improve remission rates and reduce preventable infections for these at-risk patients.

The power of exile, both self-imposed and otherwise, with regard to experiences of community is a common thread of three recent works by women: Sanctuaries of the Heart/Santuarios del corazon, a novella by Margarita Cota-Cardenas, Communal Feminisms: Chicanas, Chilenas, and Cultural Exile, a collection of interviews with prominent writer/ activists by Gabriella Gutierrez y Muhs, and Latina Activists across Borders: Women's Grassroots Organizing in Mexico and Texas, an in-depth look at feminist nongovernmen tal organizations (NGOs) by Milagros Pena. Read as a collection, these works demon strate the interconnections of the many facets of Latina women's social and political activism. All of them bring the idea that the personal is political back onto the theo retical agenda, and in all of them the "feminist lens" becomes the obvious rather than the radical choice of approach. Margarita Cota-Cardenas's earlier novella Puppet (Cota-Cardenas, 2000) has been described by Tey Diana Rebolledo (2005: x) as having "marked an important stage in the development of the Chicano narrative." Her Sanctuaries of the Heart/Santuarios del corazon is a bilingual novella (with the text appearing first in English then in Spanish) that begins with an account of the main character's experiences as a writer exploring liberation theology and the sanctuary movement in Latin America. This focus quickly slips aside, however, in favor of an interweaving of moments in the life of Petra Leyva (a character from Puppet) with theorizing on the situation of children of divorce in general and in the Mexican-American culture in particular. As the author puts it, the novel "turned out to be not about the sanctuary movement itself, but about sanctuary" (3). In a complex, emotion-filled text she explores the ways in which "sanctuary in" is similar to "exile from." She suggests that the experience of children of divorce can be thought of as internal exile—a dividing up of one's feelings between those that one inhabits and those that one is exiled from. This self-imposed separation from painful memories is a coping mechanism, but it must be overcome if one is to see one's parents and oneself as individuals and to heal.

BACKGROUND The current transition literature is a fragmented assortment of studies examining select subsections of transition stakeholders. METHODS Adolescent/young adult patients with IBD (40% transferred to adult care), parents, and health providers (53.8% adult providers) participated in 1 of 6 focus group interviews focused on concerns and needs surrounding transition to adult care. Data were analyzed through directed content analysis. RESULTS Transition needs/concerns focused on (1) losing relationships with pediatric providers, (2) perceptions of poorer quality care from adult providers, (3) high parent involvement preventing the development of youth self-management skills, and (4) finances and insurance. Suggestions to improve transition to adult care included the following: (1) meeting alone with adolescents during appointments, (2) providing concrete guidance on how/when to transition responsibility, and (3) increasing accountability for adolescents. Recommendations to improve transfer included the following: (1) providing more information about the transfer process and adult providers, (2) obtaining peer support and mentoring, and (3) setting goals and deadlines for transfer. CONCLUSIONS Inclusion of several stakeholder groups allowed for the identification of commonalities across groups as well as their unique needs and concerns surrounding transition to adult care. Concerns and recommendations by participants should be targeted in future transition program efforts.

BACKGROUND Almost 80% of adult gastroenterologists report inadequacies in the preparation of patients transferred from pediatrics. To improve transition to adult care, it is important to identify the specific deficits that patients are demonstrating before transfer. We present data from a clinic-wide assessment of transition readiness skill acquisition in adolescents/young adults with IBD. METHODS A total of 195 patients (age, 16-25 yr) with IBD completed the Transition Readiness Assessment Questionnaire. Patient age, diagnosis, time since diagnosis, physician global assessment, and patient and parent disease management confidence ratings were extracted from the medical record. Transition Readiness Assessment Questionnaire scores were compared with a benchmark established by an interdisciplinary, multi-institutional Transition Task Force. RESULTS Only 5.6% of older adolescents/young adults on the verge of transfer to adult care met our institutional benchmark (3.5% of adolescents, 7.3% of young adults). Patients reported mastery of 9.10 ± 4.68 out of 20 Transition Readiness Assessment Questionnaire items. Transition readiness was associated with older age (r = 0.27, P < 0.001) and female gender (F(1,192) = 13.81, P < 0.001) but not time since diagnosis, physician global assessment, or confidence ratings. Deficits in health care utilization/self-advocacy (e.g., understanding insurance, scheduling appointments/following up on referrals), and self-management (e.g., filling/reordering prescriptions) were observed. CONCLUSIONS Most patients on the verge of transferring to adult care are not demonstrating transition readiness. Deficits observed represent modifiable behaviors. Using data-driven assessments to guide interventions to enhance transition readiness may minimize the retention of young adult patients in pediatrics and result in patients who are better prepared for adult care.

Background:Streptococcus pneumoniae is a leading cause of severe infections, including pneumonia and meningitis, among immunocompromised patients. The administration of both the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is indicat

Examines the contribution of the library to Old Dominion University’s five‐year strategic plan, which targeted cultural diversity as one of its eight objectives and included specific statements about library support of this goal. To meet its part, the library created a three‐pronged action plan for the selection of videos, development of guides to the collection, and an evaluation of the multicultural collection, the most extensive portion of the project. Explains the choice of university minority and international student populations to assist in prioritizing collection efforts. The actual assessment project was collection‐centered; project coordinators identified a series of appropriate bibliographies to compare against the collection as the most practical way to meet defined objectives.The resulting retrospective desiderata list identified resources (once funding became available) to improve both the depth and scope of the library multicultural collections with very little impact on staffing.

Variations in chronic illness care are common in our health care system and may lead to suboptimal outcomes. Specifically, inconsistent use and suboptimal medication dosing have been demonstrated in the care of patients with inflammatory bowel disease (IBD). Quality improvement (QI) efforts have improved outcomes in conditions such as asthma and diabetes mellitus, but have not been well studied in IBD. We hypothesized that QI efforts would lead to improved outcomes in our pediatric IBD population.A QI team was formed within our IBD center in 2005. By 2007, we began prospectively capturing physician global assessment (PGA) and patient-reported global assessment. Significant QI interventions included creating evidence-based medication guidelines, joining a national QI collaborative, initiation of preclinic planning, and monitoring serum 25-hydroxyvitamin D.From 2007 to 2010, 505 patients have been followed at our IBD center. During this time, the frequency of patients in clinical remission increased from 59% to 76% (P 0.05), the frequency of patients who report that their global assessment is7 increased from 69% to 80% (P 0.05), and the frequency of patients with a Short Pediatric Crohn's Disease Activity Index (sPCDAI)15 increased from 60% to 77% (P 0.05). The frequency of repeat steroid use decreased from 17% to 10% (P 0.05). We observed an association between the use of a vitamin D supplement (P = 0.02), serum 25-hydroxyvitamin D (P 0.05), and quiescent disease activity.Our results show that significant improvements in patient outcomes are associated with QI efforts that do not rely on new medication or therapies.

Enacted interpersonal understanding was studied in 56 children from three kindergarten programs in lower socioeconomic neighborhoods: a direct-instruction program (DI) called DISTAR, representing the cultural-transmission paradigm in educational thought; a constructivist program (CON) representing the cognitive-developmental paradigm; and an eclectic program (ECL) having some characteristics of both paradigms. Pairs of children were videotaped playing a board game and dividing stickers. Selman's conceptualization of enacted interpersonal understanding at three levels of Negotiation Strategies (NS) and Shared Experiences (SE) was used in microanalytic coding of videotapes and transcripts. Analysis of 8,256 NS and SE showed a predominant use of Level 1 in all groups. The CON group consistently had the highest percentage of Level 2 and DI the lowest. The CON group was more interpersonally active, having a greater number and variety of NS and SE than the other two groups. When group differences in Level 0 NS and SE appeared, CON had the lowest percentage and DI the highest. Analysis of 292 conflicts during the game showed no differences among the groups on number or subject of conflict, but revealed the same pattern of program differences in levels of interpersonal understanding as described for the entire game. No gender differences and no differences in cognitive understanding of the game were found. No differences were found in mothers' reported childrearing attitudes and practices. Interviews on life in their classrooms showed differences among programs in children's perceptions of rules, punishments, activities, and responsibilities. Differences were observed among the groups in the degree to which children continued their activities when the teacher left the classroom. While the directinstruction group had significantly higher scores on preschool-screening tests and first-grade achievement tests than both constructivist and eclectic groups, the differences between direct-instruction and constructivist groups disappeared by third grade. Results are discussed in terms of policy implications for early education.

This prospective, Human Subjects Committee and Ethics Committee approved investigation was performed to determine if coronary angioplasty (PTCA) might be a reasonable alternative revascularization method for unstable angina patients thought to be at high risk for operative (CABG) mortality. Between March 1990 and October 1991, thirty-four consecutive patients with medically refractory rest angina were deamed to have high risk of surgical mortality and underwent PTCA without surgical backup. Predicted operative mortality was calculated for each patient based upon the VA Surgical Risk Assessment model. Angioplasty of 52 vessels was attempted. Reduction in lumenal narrowing to < 50% and improved angiographic flow was obtained in 47 vessels. There were four complicating infarctions. One death occurred in the lab, and three patients with unsuccessful angioplasty died within 30 days of pump failure. Relief of angina occurred in 30/34. Thirty patients were discharged home. In follow-up from 1 to 12 months, there have been 2 late sudden deaths at 4 months and 9 months, 1 death from lung cancer; 4 patients have stable exertional angina; 2 are awaiting heart transplant but are pain free, and one patient who had PTCA during cardiogenic shock from acute myocardial infarction had elective coronary artery bypass surgery. There have been no late myocardial infarctions. The observed angioplasty 30-day mortality of 11.8% (95% confidence limit 1% to 22.6%) compares favorably with the predicted operative mortality of 23.8% for this group. This prospective but non-randomized series supports the concept that balloon angioplasty may be a reasonable alternative to surgical intervention in some patients with unstable angina and high risk for surgery. A prospective randomized trial is warranted.