Standardized Evaluation Tool Research Articles

EPID dosimetry must soon become an essential component of IMRT quality assurance

EPID dosimetry must soon become an essential component of IMRT quality assurance

Appraising and selecting conservation measures to mitigate desertification and land degradation based on stakeholder participation and global best practices

AbstractMost desertification research focuses on degradation assessments without putting sufficient emphasis on prevention and mitigation strategies, although the concept of sustainable land management (SLM) is increasingly being acknowledged. A variety of already applied conservation measures exist at the local level, but they are not adequately recognised, evaluated and shared, either by land users, technicians, researchers, or policy makers. Likewise, collaboration between research and implementation is often insufficient. The aim of this paper is to present a new methodology for a participatory process of appraising and selecting desertification mitigation strategies, and to present first experiences from its application in the EU‐funded DESIRE project. The methodology combines a collective learning and decision approach with the use of evaluated global best practices. In three parts, it moves through a concise process, starting with identifying land degradation and locally applied solutions in a stakeholder workshop, leading to assessing local solutions with a standardised evaluation tool, and ending with jointly selecting promising strategies for implementation with the help of a decision support tool. The methodology is currently being applied in 16 study sites. Preliminary analysis from the application of the first part of the methodology shows that the initial stakeholder workshop results in a good basis for stakeholder cooperation, and in promising land conservation practices for further assessment. Study site research teams appreciated the valuable results, as burning issues and promising options emerged from joint reflection. The methodology is suitable to initiate mutual learning among different stakeholder groups and to integrate local and scientific knowledge. Copyright © 2009 John Wiley & Sons, Ltd.

Cardiovascular Magnetic Resonance Imaging for Valvular Heart Disease

Over the last half century, clinicians have employed several means to advance our knowledge of the causes and consequences of valvular heart disease. Invasive cardiac catheterization provided valuable information about hemodynamics, 2-dimensional (2D) echocardiography (echo) allowed direct visualization of the valvular apparatus and cardiac chambers, and Doppler echocardiography afforded a noninvasive tool for assessing hemodynamics and disease severity. Echocardiography is now the standard tool for initial assessment and longitudinal evaluation of patients with valvular heart disease; however, echocardiography is limited in patients with poor acoustic windows and may be more operator dependent than other modalities, particularly for quantitation of disease severity. In the last 20 years, cardiovascular magnetic resonance (CMR) has emerged as an alternative noninvasive modality without ionizing radiation that is applicable to patients with valvular heart disease. CMR provides images of valve anatomy and allows quantitative evaluation of stenosis and regurgitation. CMR can also discern the consequences of the valvular lesion, including the effects of ventricular volume or pressure overload and alterations in systolic function. The purpose of the present review is to summarize the general principles of CMR and validate CMR as a tool for evaluation of valvular heart disease. CMR uses a variety of pulse sequences to assess valvular heart disease (Table 1). A pulse sequence is a combination of transmitted radiofrequency pulses and magnetic gradients in the presence of a strong external magnetic field, from which a series of received radiofrequency pulses or “echoes” are obtained and processed into an image.1,2 View this table: Table 1. CMR Pulse Sequences for Valvular Heart Disease ### Anatomy CMR has the potential to visualize all parts of the valve (leaflets, chordae tendineae, and papillary muscles) throughout the entire cardiac cycle. Congenitally abnormal valve leaflets (bicuspid), aberrant papillary muscles or aberrant chordal attachments (parachute mitral valve), leaflet thickening, presence and extent of calcification, …

On importance sampling in the problem of global optimization

Importance sampling is a standard variance reduction tool in Monte Carlo integral evaluation. It postulates estimating the integrand just in the areas where it takes big values. It turns out this idea can be also applied to multivariate optimization problems if the objective function is non-negative. We can normalize it to a density function, and if we are able to simulate the resulting p.d.f., we can assess the maximum of the objective function from the respective sample.

Characteristics of Transcriptional Activity in Nonlinear Dynamics of Genetic Regulatory Networks

Microarray measurements of mRNA abundances is a standard tool for evaluation of transcriptional activity in functional genomics. The methodology underlying these measurements assumes existence of a direct link between transcription levels, that is, gene-specific mRNA copy numbers present in the cell, and transcription rates, that is, the numbers of gene-specific mRNA molecules synthesized per unit of time. In this paper, the question of whether or not such a tight interdependence may exist is examined in the context of nonlinear dynamics of genetic regulatory networks. Using the equations of chemical kinetics, a model has been constructed that is capable of explicitly taking into consideration nonlinear interactions between the genes through the teamwork of transcription factors. Jacobian analysis of stability has shown that steady state equilibrium is impossible in such systems. However, phase space compressibility is found to be negative, thus suggesting that asymptotic stability may exist and assume either the form of limit cycle or of a chaotic attractor. It is argued that in rapidly fluctuating or chaotic systems, direct evaluation of transcription rates through transcription levels is highly problematic. It is also noted that even if a hypothetical steady state did exist, the knowledge of transcription levels alone would not be sufficient for the evaluation of transcription rates; an additional set of parameters, namely the mRNA decay rates, would be required. An overall conclusion of the work is that the measurements of mRNA abundances are not truly representative of the functionality of genes and structural fidelity of the genetic codes.

Nippon Oil-Mitsubishi partnership likely on HS-FCC

Laboratory testing of fluid catalytic cracking (FCC) for feeds and catalysts in a confined fluid bed reactor (CFBR) is widely applied in industry as a standard evaluation tool. In this paper, comparative yields are presented from a circulating riser reactor (CRR) in an FCC pilot plant and in a standard CFBR unit. It is shown that, although a good agreement is obtained for comparative ranking of feedstock quality and catalyst activity, there are significant differences on the absolute yields obtained at constant conversion. These results are explained by differences in reactor operating parameters and their effect on catalyst performance and product selectivity.

A Theme‐based Hybrid Simulation Model to Train and Evaluate Emergency Medicine Residents

The authors sought to design an integrated theme-based hybrid simulation experience to educate and evaluate emergency medicine (EM) residents, to measure the Accreditation Council for Graduate Medical Education (ACGME) competencies using this simulation model, to measure the impact of the simulation experience on resident performance on written tests, and to measure resident satisfaction with this simulation experience. A theme-based hybrid simulation model that takes advantage of multiple simulation modalities in a concentrated session was developed and executed to both educate and evaluate EM residents. Simulation days took place at an integrated simulation center and replaced one 5-hour didactic block per quarter. Modified competency checklists were used to evaluate residents based on ACGME competencies. Written tests were administered before, during, and after simulation days. Residents were given the opportunity to evaluate the simulation days using standard residency program evaluation tools. The model was proven feasible. Core competencies were measured using the model, which was executed on four occasions in 2007. Most residents met expectations based on objective checklist criteria and subjective assessment by an observing faculty member. Data from the written tests showed no overall difference in scores measured before, during, or after the simulation days. The simulation model was rated highly useful by the residents. With the use of a highly developed simulation center and an organized, theme-based, hybrid simulation model that takes advantage of multiple simulation modalities, the authors were able to successfully develop an educational model to both train and evaluate EM residents with a high degree of resident satisfaction.

AACP Pharmacy Education Assessment Services: Outcomes, Assessment, Accountability

The Chronicle of Higher Education recently described a battle raging in higher education.1 The players are the Department of Education, accreditors, including specialty and regional bodies, and us – the US higher education establishment. The battleground is a fairly simple but incredibly important question: Who has the upper hand in establishing the outcome measures that demonstrate our education programs and processes accomplish what we say they do? How can those measures be adequately assessed for the accountability that is increasingly being called for by the government and society in general? The American Association of Colleges of Pharmacy (AACP), along with each school and college of pharmacy, embraces the accountability movement within higher education. Students, employers, and patients demand that pharmacists entering the profession demonstrate the requisite skills, knowledge, and aptitude necessary to ensure both safe and effective use of medications. Similarly, schools and colleges are challenged to demonstrate the outcomes of their programs. Such programmatic assessment includes definition of desired outcomes and the development of metrics and assessment processes for each of our missions: teaching, scholarship (including original research), patient care, and public service. The maturing of programmatic assessment which builds upon ongoing individual student assessment offers an opportunity for pharmacy education. This opportunity is embraced by AACP. AACP is taking bold action to help you meet this challenge. AACP's Pharmacy Education Assessment Services Program (PEAS), is under construction! The vision is the creation of an umbrella of diverse services and tools that will be integral to our programmatic assessment programs. AACP leadership, with insight of the Institutional Research and Assessment Committee, developed the vision for PEAS. This vision is now being translated into a number of new initiatives. It is also integrating current AACP services and tools. This melding of old, revised, and new tools will result in a comprehensive menu-driven support of schools' and colleges' assessment programs. A good example of tool development is the 4 new surveys, currently being subjected to psychometric analysis, to collect information from students, alumni, faculty, and preceptors. One area in critical need of tool development is experiential education. Our preceptors, serving an average of 2.5 schools/colleges, are asking for standardized evaluation tools to help them consistently evaluate our students. Likewise, as already exemplified by the work of the Academic Practice Partnership Initiative and the CRYSTAL APPLE Awards program, schools can use nationally developed tools to train and evaluate their preceptors. The PEAS vision also includes a process whereby AACP will peer review assessment tools developed by AACP members and public/private partners. Such tools will likely include student and faculty portfolio systems, peer teaching evaluations tools, and tools for curricular mapping and mapping of curricular competencies to outcomes. Central to PEAS will be an online desktop Self-Study Management System. This system will enable faculty and administrators to collect and analyze the longitudinal data needed to meet the annual reporting requirements of the Accreditation Council of Pharmacy Education (ACPE), as well as complete the more comprehensive self-study process. Clearly, the “bolus” approach to self-study and accreditation accountability occurring every 6 years is past. The vision is for the full complement of AACP institutional research data, including the financial and faculty salary data, to be managed each year through PEAS. Likewise, the ACPE-mandated surveys of faculty, alumni, preceptors, and graduating students will be accessed and traced through PEAS. An important component of this new commitment to assessment is the further maturation of a learning community where those with responsibility for building and leading the academy's assessment efforts can share experiences, tools, and strategies integral to the review and continuous improvement of our programs. Blogs, podcasts, webinars, live programming, institutes, seminars, and consultants will convene in cyberspace and in person to advance our programs. Such advances are best developed through AACP achieving efficiency in manpower and technology costs. Even more importantly, through AACP we can harness the collective experience of our schools and colleges to identify those best practices and metrics which provide evidence of quality pharmaceutical education. Assessment. outcomes: 2 words that strike at the heart of every faculty member and administrative leader's responsibility. We seek your input, guidance, and feedback as PEAS evolves.

Real Options: Applications in Public Economics

This paper illustrates the use of real options principles to value prototypical resource and industryinvestment projects. It captures important competitive/strategic dimensions in a step-by-stepanalysis of investment decisions (options) under uncertainty. It compares and contrasts staticdiscounted cash flow analysis (DCF) with real options analysis using three case studies. The initialexample values a resource extraction process using static DCF and then compares the projectvaluation when future information is valued and acted upon. The second example considers a coaldevelopment and uses the binomial valuation approach to capture the option value associated withhaving the right but not the obligation to exit the development. It contrasts this valuation approachagainst static DCF and highlights that future royalty payments could be underestimated if based onthe standard DCF valuation. The third example analyses the impact of providing a subsidy forhybrid vehicle production to accelerate potential uncertain environmental benefits. Lastly, thesuitability of the standard financial and economic evaluation tools used by treasury agencies isconsidered when projects contain real options.

The Subinternship Curriculum in Internal Medicine: A National Survey of Clerkship Directors

Background: The 4th-year internal medicine subinternship (subI), with its strong emphasis on experience-based learning and increased patient responsibilities, is an important component of undergraduate medical education. Discussions have begun amongst educational leaders on the importance of standardizing curriculum and evaluation tools utilized during the subinternship. Purpose: The objective of this survey was to describe the current state of educational practices regarding the subI curriculum, use of Clerkship Directors in Internal Medicine (CDIM) curricular guidelines, evaluation methodologies, and subintern call frequency and duty hours. Methods: The survey was a part of the CDIM annual survey sent to 109 institutional members in 2005. The subinternship survey included 17 questions that addressed the prevalence of formal curricula in the subinternship, use of CDIM curricular guidelines and resources, and the evaluation tools utilized for assessment of the subinternship. Two questions examined the call frequency and duty hours of the subinterns. Results: Eighty-eight members responded (81%). Of the respondents, 37% have a formal curriculum and 35% used CDIM curricular guidelines for the subinternship. More than half of the respondents agreed that the curricular guide helped organize their subI rotations (53%), and 48% agreed that it enhanced the quality of subI education. A global rating summative evaluation form (56%) was the most commonly used evaluation tool in the subinternship. Objective Structured Clinical Examinations 1−3 (1%) and Mini-Clinical Evaluation Exercise (mini-CEX) 4 (2%) were much less utilized during the subinternship. The respondents expressed an interest in the development of a standardized exam (47%) and clinical assessment tools such as the mini-CEX (59%). The vast majority of IM subinterns participate in 3 to 9 calls per rotation and spend less than 80 hr in the hospital per week. Conclusions: A formal curriculum is offered in slightly more than one third of subIs. Clerkship directors expressed interest in developing standardized evaluation tools to assess subintern competencies. The majority of IM subinterns spend less than 80 hr in the hospital per week. Further studies are needed to assess barriers to incorporating a formal curriculum and develop standardized tools to assess subintern competencies.

Evaluation of a Multidisciplinary Pediatric Mock Trauma Code Educational Initiative: A Pilot Study

Our aim was to develop and evaluate a multidisciplinary pediatric mock trauma code orientation program for residents on their pediatric hospital rotation. A before and after evaluation of trauma team residents from various programs was conducted. The 1-hour educational session consisted of a 15-minute mock trauma code, a debriefing and teaching intervention, and then a new, postintervention mock trauma code. Before and after each session, residents completed a self-assessment questionnaire. All codes were videotaped and later evaluated by two blinded observers using a standardized evaluation tool to assess patient management and team functioning. Thirty-seven prequestionnaire (pre) and postquestionnaire (post) pairs were completed. Residents reported a significant improvement in their (1) comfort in managing pediatric trauma (median pre 3, post 5, p < 0.001); (2) understanding of their role on the trauma team (median pre 4.5, post 6, p < 0.001); (3) familiarity with the resuscitation room (median pre 4, post 5, p = 0.001); (4) comfort with procedural skills (median pre 4, post 5, p = 0.001); (5) awareness of pediatric trauma resuscitation management priorities (median pre 5, post 6, p = 0.007). Postintervention, residents reported lower knowledge scores in locating equipment in the resuscitation room (p < 0.001). There was no significant difference in team performance on the videotaped assessments (premean score = 79.8, postmean score = 79.5). The pediatric mock trauma code educational initiative improved residents' self-reported confidence, knowledge, and comfort level in managing pediatric trauma. The experience also raised residents' awareness of knowledge gaps. We were unable to measure a significant change in team functioning post intervention.

C2 Area Neurostimulation: A Surgical Treatment for Fibromyalgia

Fibromyalgia (FM), a disorder characterized by diffuse pain, fatigue, and a variety of other symptoms, is thought to derive from dysfunction of the central nervous system. Neuromodulation is a technique to treat pain from a variety of causes, including disorders of the central nervous system (CNS). Occipital nerve stimulation is a neuromodulation technique currently under study to treat various migraine headache disorders. This study examines a technique of neurostimulation that appears to affect the pain and symptoms of FM. To evaluate the effect of a new technique of peripheral neurostimulation of the C2 scalp area on pain, fatigue, depression, and quality of life in FM patients. In total, 12 patients (nine females and three males; mean age 48 years) who met criteria for FM, and with comorbid headache disorder, were trialed and implanted with this C2 area stimulation technique. Outcome was prospectively studied with standard evaluation tools at baseline, 3 and 6 months post implant. Visual Analog Scale (VAS) pain levels for FM-related pain decreased significantly at 6 months, and pain-drawing total area and number of areas colored in also decreased dramatically. Chronic fatigue and depression as assessed by the Beck Depression Inventory and Fatigue Impact Scale were markedly improved. Overall quality of life as assessed by the Health Survey Short Form 36 (SF-36) was markedly improved. There were no infectious or technical complications. C2 area scalp stimulation may diminish pain and related symptoms in patients with FM.

Treatment of Radiation Proctitis

Late complications of pelvic radiotherapy occur in 5–20% of patients, particularly chronic radiation proctitis (CRP). Rectal bleeding is the most common symptom. Other symptoms include difficulty in defaecation or tenesmus because of loss of distensibility of the rectum or rectal structuring. Treatment options of CRP include oral therapy (5-aminosalicylates, metronidazole), rectal instillation therapy (hydrocortisone, sucralfate, 5-aminosalicylates, formalin), thermal therapy (argon plasma coagulation, heater probe or laser) and hyperbaric oxygen. It is difficult to recommend evidence-based therapy. There are no adequately powered studies of the treatment of CRP and most data are uncontrolled, non-blinded observation studies from single sites. There are no standard evaluation tools (including endoscopic grading, symptom scores and quality-of-life scores), adequate description of preceding radiotherapy dose or adequate follow-up in most studies. Many studies have poor documentation of complications and few are carried out prospectively. A pragmatic approach is to use sucralfate enemas and oral metronidazole. Thermal methods seem to be effective and safe. Simple heater probe treatment or argon plasma coagulation are the preferred methods due to their better safety profile. Intra-rectal formalin seems to be effective, but possibly has a higher rate of complications. For resistant disease, hyperbaric oxygen may be an option.

Assessment of Functional Capacity in Clinical and Research Settings

The assessment of functional capacity reflects the ability to perform activities of daily living that require sustained aerobic metabolism. The integrated efforts and health of the pulmonary, cardiovascular, and skeletal muscle systems dictate an individual’s functional capacity. Numerous investigations have demonstrated that the assessment of functional capacity provides important diagnostic and prognostic information in a wide variety of clinical and research settings. This scientific statement, an update of the previously published American Heart Association (AHA) document,1 highlights the major clinical and research applications of functional capacity assessment. For a comprehensive review of exercise testing, the reader is referred to the American College of Cardiology (ACC)/AHA Guidelines for Exercise Testing.2,3 Functional capacity is the ability of an individual to perform aerobic work as defined by the maximal oxygen uptake (Vo2max), that is, the product of cardiac output and arteriovenous oxygen (a−Vo2) difference at physical exhaustion, as shown in the following equation: ![Formula][1] Where HR indicates heart rate and SV indicates stroke volume. Because Vo2max typically is achieved by exercise that involves only about half of the total body musculature, it is generally believed that Vo2max is limited by maximal cardiac output rather than peripheral factors.4 Although Vo2max is measured in liters of oxygen per minute, it usually is expressed in milliliters of oxygen per kilogram of body weight per minute to facilitate intersubject comparisons. In addition, functional capacity, particularly when estimated from the work rate achieved rather than directly measured Vo, is frequently expressed in metabolic equivalents (METs), with 1 MET representing the resting energy expenditure (≈3.5 mL O2 · kg−1 · min−1). In this instance, functional capacity is commonly expressed clinically as a multiple of the resting metabolic rate. Vo2max … [1]: /embed/graphic-1.gif

ClassBench: A Packet Classification Benchmark

Packet classification is an enabling technology for next generation network services and often a performance bottleneck in high-performance routers. The performance and capacity of many classification algorithms and devices, including TCAMs, depend upon properties of filter sets and query patterns. Despite the pressing need, no standard performance evaluation tools or filter sets are publicly available. In response to this problem, we present <i xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ClassBench</i> , a suite of tools for benchmarking packet classification algorithms and devices. <i xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ClassBench</i> includes a <i xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">filter set generator </i> that produces synthetic filter sets that accurately model the characteristics of real filter sets. Along with varying the size of the filter sets, we provide high-level control over the composition of the filters in the resulting filter set. The tool suite also includes a <i xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">trace generator</i> that produces a sequence of packet headers to exercise packet classification algorithms with respect to a given filter set. Along with specifying the relative size of the trace, we provide a simple mechanism for controlling locality of reference. While we have already found <i xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ClassBench</i> to be very useful in our own research, we seek to eliminate the significant access barriers to realistic test vectors for researchers and initiate a broader discussion to guide the refinement of the tools and codification of a formal benchmarking methodology. (The <i xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ClassBench</i> tools are publicly available at the following site: http://www.arl.wustl.edu/~det3/ClassBench/.)

Managing Memory and Metamemory Impairments in Individuals with Traumatic Brain Injury

Managing Memory and Metamemory Impairments in Individuals with Traumatic Brain Injury

Patient Satisfaction as an Endoscopy Training Evaluation Tool for Nurses Performing Flexible Sigmoidoscopy

Purpose: A program to train registered nurses to perform flexible sigmoidoscopy (FS) has been developed in Ontario, Canada to create increased endoscopy capacity to screen for colorectal cancer. The nurses initially undertook simulator training and they have begun performing procedures on patients. This represents a new role for nurses in Ontario. Objectives: To develop standardized evaluation tools to monitor nurses' performance of FS on patients. Methods: Evaluation of performance on patients was conducted by checklists and global assessments completed by expert observers and by patients completing a patient satisfaction survey. We modified the Patient Satisfaction Questionnaire III (PSQ-III) to include five domains: interpersonal aspects, communication, technical quality, time spent with provider, and general satisfaction. Results: Five nurse trainees have performed at least ten procedures each. Figure 1 shows the general satisfaction scores of patients seen by two different trainees. It demonstrates that with increasing experience, an improving profile is seen for one trainee (Figure 1a) but a deteriorating profile is seen for another (Figure 1b). These trends are supported by the evaluations obtained by checklists and global assessments. (Data not shown.)FigureConclusions: These preliminary data show that the general satisfaction of patients improves with increasing skill of the nurse trainee and they may help differentiate between endoscopists with good skill level and those with poor skill level. The trainees continue to see patients and further data will be collected and evaluated. [figure 1][figure 2]Figure

Yield of Capsule Endoscopy Includes Significant Gastric Findings, and Is Unaffected By Antiplatelet Or Anticoagulation Agents

Background: Capsule endoscopy (CE) is considered the gold standard diagnostic tool in evaluation of obscure bleeding of small bowel (SB) origin, but offers limited gastric imaging as well. All patients undergoing CE have had (-) upper & lower endoscopic studies, and many are on anticoagulation or antiplatelet therapy (Acptx). Aim: We wished to determine whether CE may find a significant number of missed gastric bleeding sources and studied whether the yield of CE differed in those on or off Acptx. Methods: Patients w/obscure GI bleeding referred for CE were retrospectively studied. All gastric and SB images were viewed by one of two experienced MDs. Hx, indications (Group:A-ongoing overt bleeding, B-previous overt bleeding, C-Fe def/heme +) and use of aspirin (ASA), Plavix and/or coumadin at time of capsule was obtained from EMR review. Evidence of bleeding (red blood-RB,coffee grounds-CG) and types of lesions in both gastric and SB images were identified and adjudicated for significance by the study PI. Results: 262 pts were referred for CE since 4/02; 175 had both bleeding indication and evaluable data. Indications were: group A: 21 pts(12%), B: 75(43%), and C: 79(45%). Gastric RB and CG was seen in 18/175 pts overall (10.3%, 10 RB, 8 CG). Associated gastric lesions were noted in the majority of these pts (10/18; 6-gastropathy, 3-erosion, 1 AVM). Of the pts with gastric blood, 13/18 (72%) had either no SB lesion or one small AVM, suggesting the gastric site was the primary cause of bleeding. Gastric blood was noted significantly more often in pts studied later in our series (3/23/04-11/05) than before (17% vs 5%, p < 0.05). There was no significant difference in the prevalence of gastric blood among pts on Acptx compared to those off (9.7% vs. 10.9%). Notably, SB lesions were found with similar frequency in those on or off any Acptx, or combinations of these agents (60.1% off, 56.6% on Acptx of any kind, 56% ASA alone, 57% combination). There was a trend toward higher frequency of RB or CG in the SB in those on Acptx, but this was not significant (12% in controls, 18% in Acptx group). Conclusions: The rate of SB findings on CE were unaffected by the presence of anticoagulation or antiplatelet therapy. We found a relatively high rate of gastric bleeding (10.3%) in our pts whether on anticoagulation or not. A significantly higher frequency of gastric blood was noted in studies done in the latter half of our series (16.1% vs. 4.5%). We expect that as CE is used earlier in the evaluation of obscure bleeding, lesions overlooked on routine endoscopy will increasingly be detected.

Hmong Childhood Obesity Prevention Program: A model pilot project in northern California

The purpose of this research project was to pilot test a culturally appropriate Hmong nutrition education curriculum, adapted to the existing California Expanded Food and Nutrition Education Program (EFNEP). The program is unique in that Hmong community members provided input in the curriculum development and were recruited from three counties to implement the 8-week program. The extenders are involved in the recruitment, delivery of the lessons and the evaluation. The curriculum emphasizes healthy eating, messages from the new Dietary Guidelines for Americans 2005 and interactive learning activities. Each lesson was designed to incorporate cultural foods and recipes, Hmong-adapted handouts and culturally tailored messages. Topics covered include maintaining healthy traditional habits, MyPyramid messages, modifying less healthy food patterns, keeping foods safe and increasing physical activity. Essential components of the lessons are family involvement, goal setting and weekly evaluation. Evaluation for the program includes formative evaluation as well as use of the standard EFNEP evaluation tools, including the food behavior checklist and 24-hour recalls. Community health workers, or more specifically, extenders, who represent and work with communities provide links between providers and the broader community and have the ability to bridge cultural gaps and assist community members in making changes.

Tools for Analysing Disaster Risk in Designing and Evaluating Projects

As the human and financial costs of disasters rise, there are increasing demands for evidence that mitigation “pays”. Until this proof exists, many development organisations remain reluctant to pursue risk reduction as a key objective, or even to protect their own projects against potential hazards. This paper outlines how such evidence could, in fact, be relatively easily obtained by integrating natural hazard related risks concerns into the design and evaluation of potential projects using standard appraisal and evaluation tools. It shows that there is nothing intrinsically difficult about either appraising risks or monitoring and evaluating the impact of related mitigation measures as part of these broader analyses - if this task is approached thoughtfully and knowledgeably, and adequately resourced. Provision of appropriate methodological tools is not sufficient in itself, however, to secure improvements in the management of risk. The paper identifies a series of further critical factors that need to be addressed in order to secure long-term commitment to risk reduction, as reflected in the broad policies, objectives and priorities of both governments and development organisations, and actual practice on the ground. In particular, development organisations and governments need to accept greater accountability for disaster-related losses. The paper is based on the findings of an ongoing ProVention Consortium project, 'Measuring Mitigation': Methodologies for Assessing Natural Hazard Risks and the Net Benefits of Mitigation.