Federal Facility Research Articles

Lessons Learned from Comprehensive Energy and Water Evaluations at U.S. Army Campus Installations

ABSTRACTThe U.S. Department of Energy's Pacific Northwest National Laboratory has engaged in a multi-year collaboration with the U.S. Army to support comprehensive energy and water evaluations at large Army campus installations. Initiated to help the Army achieve compliance with facility evaluation requirements dictated by the Energy Independence and Security Act of 2007, this effort has resulted in the evaluation of 530 buildings at 14 installations across the U.S., and the identification of annual savings potential of over 212 billion Btu of energy and 29 million gallons of water. This article highlights the nature of the evaluation process applied at these Army installations and discusses a number of key findings that can be considered for ongoing and future evaluations at Army and other federal agency facilities, particularly those buildings within campus settings.

Exploring Relationships Between Delinquent Peer Groups, Participation in Delinquency, Substance Abuse, and Injecting Drug Use Among the Incarcerated: Findings From a National Sample of State and Federal Inmates in the United States.

The following study assesses the relationship between affiliating with delinquent peer groups, participation in delinquency, and several substance misuse and injecting drug use outcomes in a nationally representative sample of inmates in state and federal facilities in the United States. After controlling for potential confounders, affiliating with peers who engaged in deviant behaviors and participation in delinquency was associated with onset of alcohol and illicit drug use, substance dependence, alcohol dependence, types of substances used, and injecting drug use outcomes. Inmates who began engaging in delinquency at older ages reported initiating drug and alcohol use at older ages, and were less likely to meet the criteria for drug abuse or dependence, less likely to use substances daily or near daily, and less likely to report having ever injected or shared syringes. The implications of these findings for substance abuse, HIV, and crime prevention interventions are discussed.

Childhood Adversities and Substance Misuse Among the Incarcerated: Implications for Treatment and Practice in Correctional Settings

ABSTRACTBackground : Incarcerated populations have high rates of childhood adversities and substance use problems. Moreover, childhood adversities are well-documented predictors of substance misuse. Objective: To investigate the impact of childhood sexual and physical abuse, caregiver abuse of drugs or alcohol, and time spent in foster care on several substance misuse outcomes. Methods: Data comes from a sample of 16,043 incarcerated men and women in the United States Survey of Inmates in State and Federal Facilities. Bivariate analyses revealed differences by sex in childhood adversities and socioeconomic characteristics. Logistic regression analyses assessed the data for a link between childhood adversities and substance misuse after adjusting for other variables. Analyses were stratified by sex to show differences in predictors of substance misuse between men and women. Results: Childhood adversities increased the risk of many substance misuse outcomes. The prevalence of physical abuse, sexual abuse, foster care, and caretaker abuse of drugs or alcohol were greatest for inmates who reported injecting and sharing drugs. Growing up with a caregiver that used drugs or alcohol was a consistent predictor of increased risk of substance misuse for men and women. However, childhood sexual abuse increased risk for only women. Conclusions: Inmates who experience physical abuse, sexual abuse, foster care involvement and caretakers who use drugs and alcohol are at an increased risk of substance misuse, injecting drug use and syringe sharing. Implications suggest correctional HIV prevention and substance misuse programs must address unresolved trauma and important gender differences.

Twelve Committed Men: the feasibility of a community-based participatory HIV-prevention intervention within a Canadian men's correctional facility.

The intervention objectives were to evaluate and describe the feasibility of using a community-based research (CBR) approach to adapt and implement HIV-prevention materials and tools with incarcerated men. We found no prior published reports about CBR HIV-prevention education in Canadian correctional facilities. Twelve members of the correctional Peer Education Committee (PEC) and Aboriginal PEC, whom a correctional nurse identified as being interested in preventive health, were purposively invited to participate. Eight participants were serving life sentences, three were Aboriginal and their education levels ranged from below grade 8 to 11 years of post-secondary education. The setting was a medium-security federal correctional facility, housing 324 men. The intervention was guided by CBR and 'greater involvement of people with AIDS' principles. Participants were invited to attend four workshops, over seven days in May 2014, and to provide their insights regarding future scaled-up CBR HIV prevention. Each workshop included an HIV-prevention presentation and a focus group discussion, two of which were audio-recorded. All participants attended all sessions. Synthesis of mixed-method findings, with quantitative and qualitative data triangulation, demonstrated two major outcomes: 'new knowledge was generated' regarding feasibility of CBR HIV prevention in a men's correction facility; and 'capacity building occurred' with increased participants' social capital. Thirty incarcerated men requested HIV testing following the intervention, because participants spread their knowledge about HIV prevention to others. Participants asked to become 'health ambassadors' - champion advisors for future scaled-up CBR HIV-prevention intervention for the entire correctional facility. CBR HIV prevention is feasible within a Canadian men's correctional facility.

The ASCA Model and a Multi-Tiered System of Supports: A Framework to Support Students of Color With Problem Behavior

Educational disparities are well documented for students of color in the United States (Delpit, 2006; Ford & Moore, 2013; U.S. Department of Education [USDOE], 2014). Today's students of color are facing lower graduation rates, overuse of exclusionary disciplinary action, overrepresentation in exceptional education programming and school policies that negatively impact students of color rather than support them (Moore, Henfield, & Owens, 2008; USDOE, 2014; R. Palmer & Maramba, 2010; Toldson & Lewis, 2012). School discipline policies based on a framework of zero tolerance have not reduced suspensions or expulsions as initially intended. Instead, these policies have resulted in more students being excluded from the classroom due to reactive disciplinary action (Skiba, 2014). Bernstein (2014) posited that these policies are increasing the educational achievement gap and negatively impacting the development of students of color. What then can be done as an alternative to or as a measure to prevent exclusionary disciplinary actions such as suspensions and expulsions?A multi-tiered system of supports (MTSS) is a systematic data-driven program designed to address academic concerns and problem behavior by utilizing both prevention and intervention strategies (Sugai & Horner, 2009). Specific to behavior-related concerns, MTSS programs offer a structured method for providing both universal and individual support for students and present data-driven alternatives to suspension and expulsion. School counselors are uniquely positioned to play a critical role in the implementation of such programs due to their training in data analysis, program development and direct service delivery. Moreover, MTSS programs align well with the American School Counselor Association (ASCA) National Model (2012a).The ASCA National Model has themes of social justice, advocacy and systemic change infused throughout, as comprehensive school counseling programs are designed to remove barriers to student success and help students reach their potential in the areas of academic, career, social and emotional development (ASCA, 2012a). With these themes in mind, integrating the National Model with the objective and data-driven framework of MTSS may offer one solution for systemic educational disparities such as the school-to-prison pipeline. The purpose of this article is to describe a model for integrating elements of the ASCA National Model within the MTSS framework. The authors will describe steps involved in the process and will provide context for how such an intervention can specifically benefit students of color.The School-to-Prison PipelineMore than 6.8 million individuals were under supervision of the adult correctional system in the United States at the end of 2014, a rate of 1 in 36 adults (Kaeble, Glaze, Tsoutis, & Minton, 2015). Of those under correctional supervision, over 1.5 million were held in state and federal correctional facilities (Carson, 2015). Although these numbers mark a slight decrease in the correctional population since 2007 (Kaeble et al., 2015), the American incarceration rate has quadrupled since the 1970s (Travis, Western, & Redburn, 2014). The growth of incarceration in the United States over the past four decades has largely affected the Black and Latino communities, both of which are disproportionately represented among individuals involved with the correctional system (Carson, 2015). Scholars in multiple academic disciplines have linked American drug policy and enforcement with mass incarceration of primarily individuals of color (Alexander, 2010; Travis et al., 2014). In education, however, a parallel cause has contributed to the expansion of the correctional system in the United States. Increasingly punitive discipline policies marked by zero tolerance approaches have created a pipeline from schools to prisons where exclusion from the educational environment and criminalization of student misbehavior contribute to school dropout and involvement with the juvenile justice system (Fowler, 2011). …

The analysis of the experience gained by the multidisciplinary team during the 5 year work in compliance with the protocol of FAST-TRAC - therapy following the surgical interventions for total endoprosthetics of the hip and knee joints based at the clinic of the federal state autonomous facility “Therapeutic and Rehabilitative Centre”, Russian Ministry of Health

This article was designed to report the results of the analysis of the duration of the hospital stay for the patients admitted to a surgical department and its grading taking into consideration the experience of the surgeons. It was shown that the patients operated on by the surgeons having the total period of service below 5 years had the shortest time of hospitalization because many of them presented with concomitant diseases and had to be referred for the further treatment to the more experienced specialists. The questionnaire study carried out within 3-6 weeks after surgery has demonstrated that 31% of the patients treated in compliance with the principles of fast-track therapy remained fully mobile without any restrictions on the distances they were able to cover. The mobility of 53% of the treated patients was confined to their personal apartments and the adjacent courtyards while 31% of them could move only within their apartments. The analysis of the degree of satisfaction of the patients with the medical assistance provided to them showed that 26% of the patients experienced the substantial improvement of their health status, 74% described the improvement as moderate, and 4% appeared unsatisfied with the outcome of the treatment. The analysis of pain sensations in the treated patients revealed the absence of pain in 46% of them whereas 36% estimated the intensity of pain syndrome as 1-5 scores based on the NRS scale whereas 17% estimated pain intensity as being higher than 5 scores. The analysis of the social competence and household skills of the treated patients showed that 38% of them expressed the desire to resume their routine professional activities within 1-2 months after the completion of the treatment, another 34% were prepared to do the same within 2-4 months, and the remaining 27% were ready to work again within 6 months after surgery. Only 2% of the patients did not plan to return to their habitual mode of life. The article expounds the main differences of the concept of fast-track therapy being realized at the clinic of the federal state autonomous facility “Therapeutic and Rehabilitative Centre”, Russian Ministry of Health, from that adopted in analogous foreign healthcare facilities. It is concluded that the modified concept based at our clinic provides a safe and efficient tool for the management of surgical patients.

Paternal Incarceration and Family Functioning

This article extends research on the association between paternal incarceration and family functioning by differentiating between families with fathers who have been incarcerated in local jails, state prisons, federal prisons, and unknown types of facilities. Data from the Fragile Families and Child Wellbeing Study (FFCW) enable this finer grained analysis. We show that there are few observable differences between families with fathers incarcerated in a local, state, or federal facility and the 53 percent of families with fathers incarcerated in an unknown facility type. We test the association between facility type and family functioning using a series of fixed effects models, showing strong associations between facility type and only two of seven family outcomes. The evidence presented here suggests that family functioning does not markedly vary by type of facility, but this finding needs to be substantiated in future research.

Ion mobility spectrometry nuisance alarm threshold analysis for illicit narcotics based on environmental background and a ROC-curve approach.

The discriminative potential of an ion mobility spectrometer (IMS) for trace detection of illicit narcotics relative to environmental background was investigated with a receiver operating characteristic (ROC) curve framework. The IMS response of cocaine, heroin, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), and Δ(9)-tetrahydro-cannabinol (THC) was evaluated against environmental background levels derived from the screening of incoming delivery vehicles at a federal facility. Over 20 000 samples were collected over a multiyear period under two distinct sets of instrument operating conditions, a baseline mode and an increased desorption/drift tube temperature and sampling time mode. ROC curves provided a quantifiable representation of the interplay between sensitivity (true positive rate, TPR) and specificity (1 - false positive rate, FPR). A TPR of 90% and minimized FPR were targeted as the detection limits of IMS for the selected narcotics. MDMA, THC, and cocaine demonstrated single nanogram sensitivity at 90% TPR and <10% FPR, with improvements to both MDMA and cocaine in the elevated temperature/increased sampling mode. Detection limits in the tens of nanograms with poor specificity (FPR ≈ 20%) were observed for methamphetamine and heroin under baseline conditions. However, elevating the temperature reduced the background in the methamphetamine window, drastically improving its response (90% TPR and 3.8% FPR at 1 ng). On the contrary, the altered mode conditions increased the level of background for THC and heroin, partially offsetting observed enhancements to desorption. The presented framework demonstrated the significant effect environmental background distributions have on sensitivity and specificity.

Baptized in PCBs: Race, Pollution, and Justice in an All-American Town by Ellen Griffith Spears

Reviewed by: Baptized in PCBs: Race, Pollution, and Justice in an All-American Town by Ellen Griffith Spears Rebecca Bond Costa Baptized in PCBs: Race, Pollution, and Justice in an All-American Town. By Ellen Griffith Spears. Chapel Hill: The University of North Carolina Press, 2014. xiii, 440 pp. ISBN 978-1-4696-1171-6. In Baptized in PCBs: Race, Pollution, and Justice in an All-American Town, Ellen Griffith Spears describes how Anniston, Alabama, transitioned from a “healthful Eden” during the nineteenth century to “Toxic Town, USA” by the early 2000s (18). The events leading to that shift took place over the course of about one hundred years and were rooted in the South’s economic boosterism, the growth of the American military, and the long-standing presence of racism. When Anniston’s residents learned about the dangerous chemical legacy left by industry and the military in their town, citizens mobilized to protect their homes and bodies from further contamination. In addition to the forces that initially brought chemicals to Anniston, a history of civil rights activism and a burgeoning environmental justice movement shaped responses to the toxic threats that came from both the past and present. Though much of the book focuses on “the Model City of the South,” Spears convincingly argues that the pollution and activism that took place at the local level in Anniston were actually manifestations of global trends (21). The impact of industrial development, war, racism, and pollution could be seen not just in Alabama, but nationally and internationally as well. Spears traces the conditions that led to the pollution of Anniston by Monsanto Chemical Company, as well as the story of how the United States military brought chemical weapons to the area. About four decades after the town’s founding, a group of Alabama entrepreneurs established several businesses that were related to munitions manufacturing and the rapidly developing field of synthetic chemicals. Influenced by events in World War I, the chemical industry looked for ways to harness the power of chemicals for both military and commercial interests. By the early 1930s, Swann Chemical Company in west Anniston was making a product called Aroclors—the brand name for a group of chemicals in the Polychlorinated Biphenyls (PCB) family. The compound became widely used by industries that needed lubricants which could withstand intense [End Page 259] levels of heat. When the Great Depression began to negatively impact Swann, Monsanto Chemical Company gained controlling interest in the business and assumed responsibility for manufacturing Aroclors. Monsanto continued producing PCBs through the 1970s, despite warnings from researchers that the compound was potentially hazardous to the health of wildlife and humans. Because the company did not share internal reports detailing the potential dangers of PCBs, residents remained unaware that the benefits of having an industrial neighbor also carried considerable peril. Lax pollution control measures and inadequate government regulations further elevated the risks faced by the local population. Monsanto Chemical Company was not the only major force in the area’s economy after World War I. In Anniston and throughout the South, the U.S. military employed a significant number of people and generated considerable revenues for surrounding locales. Several military facilities were located in Anniston during the mid–1900s, including the headquarters for the Army’s Chemical Corps. Residents were aware that the Army tested chemical weapons near their town, but citizens had little knowledge that the military also kept large stockpiles of sarin gas or VX nerve agent in the Anniston Army Depot. Spears argues that questioning the military seemed like an ill-advised idea, especially when residents depended on the money generated by having those federal facilities nearby. Two events galvanized environmental activism in Anniston in the waning decades of the twentieth century. The first came in the late 1980s, when citizens finally learned about the chemical weapons that were stored close to their town and that the Army planned to dispose of those stockpiles through incineration. A few years later, deformed catfish were discovered in Choccolocco Creek, prompting investigations into possible causes. Official testing revealed that unsafe levels of PCBs had been found in every sample of fish. In both instances, local residents mobilized to hold...

AMA Council Report Calls for End to Nonmedical Vaccination Exemptions

AMA Council Report Calls for End to Nonmedical Vaccination Exemptions

Judicial Intervention into Prisons: Comparing Private and Public Prisons from 1990 to 2005

ABSTRACTA mid-twentieth century prisoners’ rights revolution gave American prisoners unprecedented access to courts for exercising newly elaborated constitutional rights. The result was a tide of litigation brought by inmates and subsequent remedial court orders requiring corrections officials to improve conditions of confinement. It was in this context of aggressive judicial intervention into prison operations that the private prison industry emerged. Some early proponents of prison privatization claimed that the private sector could provide superior prison conditions and thereby reduce judicial intervention. This article assesses this claim empirically. It uses data on state and federal adult correctional facilities from the Bureau of Justice Statistics to compare the prevalence of reported court orders among public and private correctional facilities in the United States from 1990 through 2005. Results from a series of logistic regression analyses reveal that privatization has had little effect on the likelihood of judicial intervention into correctional facilities.

Geospatial analytics for federally managed tourism destinations and their demand markets

Abstract Understanding geospatial demand for destinations can improve management decisions affecting destination planning, marketing, natural preservation, and resident as well as visitor experiences. Visualization and analysis of demand markets are significantly enhanced by the capabilities of Geographic Information System (GIS) technology and help to support management objectives. This study implements traditional desktop GIS as well as a free, web-delivered decision-support tool for tourism planning and marketing to assess ~7.5 million overnight accommodation reservations made for federal recreational facilities between 1999 and 2007. Visitor origin frequency and median travel distance for overnight accommodations are summarized by visitor zip code and by facility. National results indicate: (1) facilities in the west, the Great Lakes and the southern Appalachians regions draw overnight visitors from the greatest median distances; (2) residents in the Northeast have the lowest per-capita utilization; (3) residents within the south-central Midwest and central-west Southern States have the highest percapita utilization and tend strongly toward local overnight reservations. Three selected national park regions are used to illustrate destinations characterized by highly localized utilization (Hot Springs National Park, AR), both local and regional utilization (Yosemite National Park, CA) and regionally to nationally dispersed utilization with few local residents reserving overnight accommodations (Canyonlands National Park, UT). Market profiling derived from local, regional and national customer origin markets can help any tourism destination, including national parks and their gateway communities, make smarter management and marketing decisions.

Prevalence and factors associated with smoking tobacco among men recently released from prison in California: A cross-sectional study

BackgroundOver 1.5 million people are incarcerated in state and federal correctional facilities in the United States. Formerly incarcerated men have significantly higher rates of mortality and morbidity than the general population, disparities that have been partially attributed to higher rates of tobacco smoking-related illnesses such as cardiovascular disease, pulmonary disease and cancer. MethodsWe compared the prevalence of smoking tobacco in a sample of 172 men who were released from California state prisons to Oakland and San Francisco between 2009 and 2011 to sub-populations of respondents to the 2009 California Health Interview Survey (CHIS). Using logistic regression, we analyzed the association between lifetime history of incarceration and self-reported smoking status. ResultsSeventy-four percent of men recently released from prison reported being current tobacco smokers. The prevalence of smoking in a demographically similar group of men in the CHIS was 24%. We found in bivariate analysis that each additional five years of history of incarceration was associated with 1.32 times greater odds of smoking (95% CI 1.02 to 1.71). Illicit substance use was associated with a 2.47 higher adjusted odds of smoking (95% CI 1.29 to 5.39). In the multivariate model adjusting for age, income, substance use and mental health, every five years of incarceration was associated with 1.23 greater odds of smoking (95% CI 0.94 to 1.63) which was not statistically significant. ConclusionsGiven the high prevalence of smoking tobacco among former prisoners and the underlying high tobacco-related mortality rates, these findings suggest that a history of incarceration may be an important determinant of smoking. Prison and parole systems may be important potential settings for smoking-cessation interventions.

Vestibular Dysfunction in Patients with Enlarged Vestibular Aqueduct.

Enlarged vestibular aqueduct (EVA) is the most common inner ear malformation. While a strong correlative relationship between EVA and hearing loss is well established, its association with vestibular dysfunction is less well understood. In this study, we examine the effects of EVA on the vestibular system in patients with EVA. Prospective, cross-sectional study of a cohort ascertained between 1999 and 2013. National Institutes of Health Clinical Center, a federal biomedical research facility. In total, 106 patients with unilateral or bilateral EVA, defined as a midpoint diameter greater than 1.5 mm, were referred or self-referred to participate in a study of the clinical and molecular aspects of EVA. Clinical history was ascertained with respect to the presence or absence of various vestibular signs and symptoms and history of head trauma. Videonystagmography (VNG), cervical vestibular evoked myogenic potential (cVEMP), and rotational vestibular testing (RVT) were performed to assess the vestibular function. Of the patients with EVA, 45% had vestibular signs and symptoms, and 44% of tested patients had abnormal VNG test results. An increased number of vestibular signs and symptoms was correlated with the presence of bilateral EVA (P = .008) and a history of head injury (P < .001). Abnormal VNG results also correlated with a history of head injury (P = .018). Vestibular dysfunction is common in patients with EVA. However, not all patients with vestibular signs and symptoms have abnormal vestibular test results. Clinicians should be aware of the high prevalence of vestibular dysfunction in patients with EVA.

Research on the health of people who experience detention or incarceration in Canada: a scoping review.

BackgroundWe conducted a scoping review to define the extent and type of quantitative health status research conducted from 1993 to 2014 with people who have experienced detention or incarceration in correctional facilities in Canada.MethodsWe searched 15 databases, reviewed reference lists and relevant websites, and consulted with key stakeholders to identify eligible studies. We reviewed records for eligibility and extracted relevant data from eligible articles.ResultsWe identified 194 studies that were eligible for inclusion. Most studies were conducted with males and with persons in federal facilities, and focused on mental health, substance use, and social determinant of health outcomes.ConclusionsHealth status data are limited for several outcomes, such as chronic disease, injury and sexual and reproductive health, and for persons in provincial facilities and post-release. Efforts should be made to improve data collection and knowledge dissemination, so that relevant data can be used more effectively to improve health and health care in this population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1758-6) contains supplementary material, which is available to authorized users.

Evacuate or Shelter-in-place? The Role of Corporate Memory and Political Environment in Hospital-evacuation Decision Making.

Hospital-evacuation decisions are rarely straightforward in protracted advance-warning events. Previous work provides little insight into the decision-making process around evacuation. This study was conducted to identify factors that most heavily influenced the decisions to evacuate the US Department of Veterans Affairs (VA) New York Harbor Healthcare System's (NYHHS; New York USA) Manhattan Campus before Hurricane Irene in 2011 and before Superstorm Sandy in 2012. Semi-structured interviews with 11 senior leaders were conducted on the processes and factors that influenced the evacuation decisions prior to each event. The most influential factor in the decision to evacuate the Manhattan Campus before Hurricane Irene was New York City's (NYC's) hospital-evacuation mandate. As a federal facility, the Manhattan VA medical center (VAMC) was exempt from the city's order, but decision makers felt compelled to comply. In the case of Superstorm Sandy, corporate memory of a similar 1992 storm that crippled the Manhattan facility drove the decision to evacuate before the storm hit. Results suggest that hospital-evacuation decisions are confounded by political considerations and are influenced by past disaster experience. Greater shared situational awareness among at-risk hospitals, along with a more coordinated approach to evacuation decision making, could reduce pressure on hospitals to make these high-stakes decisions. Systematic mechanisms for collecting, documenting, and sharing lessons learned from past disasters are sorely needed at the institutional, local, and national levels.

FDA continues to release compounding guidance

FDA continues to issue guidance on how to enforce the Drug Quality and Security Act after the compounding law was enacted in late 2013.

The Art of Commissioning: A Cost Benefit Analysis of 23 Large-scale Federal Facilities

ABSTRACTEnergy is being wasted, possibly unrecognizably, on a daily basis when commissioning is not performed. This results in a reduction in profit, equipment lifespan and overall sustainability. Common misconceptions can be that operating systems are already efficient since they work, making commissioning unnecessary, and that there is not much benefit from periodically commissioning a building throughout its lifespan.This research details pre-commissioning energy consumption versus post-commissioning as well as commissioning costs of three different test groups of facilities which have undertaken various commissioning projects. This article will be a logical argument to motivate building owners to consider commissioning.

Implementation of National HIV Screening Recommendations in the Indian Health Service.

The Indian Health Service (IHS), a federal agency, provides direct patient care to an estimated 1.9 million American Indian/Alaska Native patients across a large and decentralized network of health facilities. The IHS sought to implement HIV screening of adults and adolescents per national recommendations. The IHS facilities received technical support such as electronic clinical reminders (ECRs) and sample HIV-testing policies. To determine what facility-wide policy and practices were associated with high HIV screening rates. Survey of clinical directors of 61 federal health facilities on use of ECRs, testing policies/standing orders, and other factors associated with HIV screening. These results were correlated with HIV screening performance results for each facility as derived from the IHS national database. A total of 51 (84%) of 61 facilities were interviewed. In univariate analysis, factors that were correlated with higher rates of HIV screening were having an HIV screening standing order (unadjusted odds ratio [UOR] 8.7, 95% confidence interval [CI] 2.0-37.3), sexually transmitted disease (STD) screening standing order (UOR 5, CI 1.1-21.7), having an HIV ECR in place for a year or longer (UOR 10.2, CI 2.8-37.5), and inclusion of both providers and nurses in offering HIV screening (UOR 4.8, CI 1.4-16.7). In multivariate analysis, ECRs (adjusted odds ratio [AOR] 9.1, 95% CI 1.8-45.1) and STD standing orders (AOR 7.4, 95% CI 1.1-51.0) remained significantly associated with higher HIV screening. Policy and practice interventions such as ECRs and standing order/testing policies and delegation of screening are correlated with high HIV screening, are scalable across health networks, and will be used for improving other infectious disease screening indicators in such as STD and hepatitis C.

A case history in architectural acoustics: Security, acoustics, the protection of personally identifiable information (PII), and accessibility for the disabled

This paper discusses the re-design of a field office to enhance the protection of Personally Identifiable Information (PII), physical security, and accessibility for the disabled at the Social Security Administration (SSA) field office in Roxbury, MA. The study, and its results can be used at federal, civil, and private facilities where transaction window type public interviews occur. To protect the public and its staff, the SSA has mandated heightened security requirements in all field offices. The increased security measures include: Installation of barrier walls to provide separation between the public and private zones; maximized lines of sight, and increased speech privacy for the protection of PII. This paper discusses the use of the Speech Transmission Index (STI) measurement method used to determine the post construction intelligibility of speech through the transaction window, the acoustical design of the windows and their surrounding area, how appropriate acoustic design helps safeguard personal and sensitive information so that it may be securely communicated verbally, as well as improved access for the disabled community, especially the hearing impaired.