Years Of Field Experience Research Articles

Early Childhood Teachers' and Staff Members' Perceptions of Nutrition and Physical Activity Practices for Preschoolers

Child care teachers and staff are important influences on preschoolers' nutrition and physical activity habits, and their views may be influenced by education level, years of field experience, and program involvement. For the 360 participants surveyed, responses on 5 of 18 survey items significantly differed by education level (e.g., less education led to more agreement about difficulty with foods at school). Years of field experience significantly differed on three items, such as less experience led to agreeing that government guidelines were helpful. Perceptions significantly differed between Head Start and other programs' staff on two items about food and activity school practices. Following the survey, 32 Head Start professionals participated in focus groups, yielding 16 main ideas among three broad themes involving teachers' roles, perceptions, and strategies concerning nutrition and physical activity practices. Roles revolved around use of Head Start guidelines and checklists. Perceptions included (1) mealtime routines, (2) menus, (3) planned physical activity time, and (4) sedentary lifestyles. Strategies included (1) posting weekly menus and lesson plans, (2) working with the dietitian for classroom ideas, (3) using music to encourage movement, and (4) having large motor areas. Recommendations for future research, policy initiatives, and educational implications are suggested.

Freedom is not enough: Haiti's sustainability in peril

The following article examines Haiti's past, present and future sustainability based on a thorough cause and effect analysis of the country's current situation, research on relevant social and economic factors, years of field experience, as well as training and consulting for businesses, political parties and non-profit organisations. In addition to identifying the current major core conflicts of Haiti, the article also suggests solutions to various social, economical and environmental issues.

Feasibility, Drug Safety, and Effectiveness of Etiological Treatment Programs for Chagas Disease in Honduras, Guatemala, and Bolivia: 10-Year Experience of Médecins Sans Frontières

BackgroundChagas disease (American trypanosomiasis) is a zoonotic or anthropozoonotic disease caused by the parasite Trypanosoma cruzi. Predominantly affecting populations in poor areas of Latin America, medical care for this neglected disease is often lacking. Médecins Sans Frontières/Doctors Without Borders (MSF) has provided diagnostic and treatment services for Chagas disease since 1999. This report describes 10 years of field experience in four MSF programs in Honduras, Guatemala, and Bolivia, focusing on feasibility protocols, safety of drug therapy, and treatment effectiveness.MethodologyFrom 1999 to 2008, MSF provided free diagnosis, etiological treatment, and follow-up care for patients <18 years of age seropositive for T. cruzi in Yoro, Honduras (1999–2002); Olopa, Guatemala (2003–2006); Entre Ríos, Bolivia (2002–2006); and Sucre, Bolivia (2005–2008). Essential program components guaranteeing feasibility of implementation were information, education, and communication (IEC) at the community and family level; vector control; health staff training; screening and diagnosis; treatment and compliance, including family-based strategies for early detection of adverse events; and logistics. Chagas disease diagnosis was confirmed by testing blood samples using two different diagnostic tests. T. cruzi-positive patients were treated with benznidazole as first-line treatment, with appropriate counseling, consent, and active participation from parents or guardians for daily administration of the drug, early detection of adverse events, and treatment withdrawal, when necessary. Weekly follow-up was conducted, with adverse events recorded to assess drug safety. Evaluations of serological conversion were carried out to measure treatment effectiveness. Vector control, entomological surveillance, and health education activities were carried out in all projects with close interaction with national and regional programs.ResultsTotal numbers of children and adolescents tested for T. cruzi in Yoro, Olopa, Entre Ríos, and Sucre were 24,471, 8,927, 7,613, and 19,400, respectively. Of these, 232 (0.9%), 124 (1.4%), 1,475 (19.4%), and 1,145 (5.9%) patients, respectively, were diagnosed as seropositive. Patients were treated with benznidazole, and early findings of seroconversion varied widely between the Central and South American programs: 87.1% and 58.1% at 18 months post-treatment in Yoro and Olopa, respectively; 5.4% by up to 60 months in Entre Ríos; and 0% at an average of 18 months in Sucre. Benznidazole-related adverse events were observed in 50.2% and 50.8% of all patients treated in Yoro and Olopa, respectively, and 25.6% and 37.9% of patients in Entre Ríos and Sucre, respectively. Most adverse events were mild and manageable. No deaths occurred in the treatment population.ConclusionsThese results demonstrate the feasibility of implementing Chagas disease diagnosis and treatment programs in resource-limited settings, including remote rural areas, while addressing the limitations associated with drug-related adverse events. The variability in apparent treatment effectiveness may reflect differences in patient and parasite populations, and illustrates the limitations of current treatments and measures of efficacy. New treatments with improved safety profiles, pediatric formulations of existing and new drugs, and a faster, reliable test of cure are all urgently needed.

Paramedic Self-Reported Medication Errors

Background. Continuing quality improvement (CQI) reviews reflect that medication administration errors occur in the prehospital setting. These include errors involving dose, medication, route, concentration, andtreatment. Methods. A survey was given to paramedics in San Diego County. The survey tool was established on the basis of previous literature reviews andquestions developed with previous CQI data. Results. A total of 352 surveys were returned, with the paramedics reporting a mean of 8.5 years of field experience. They work an average of 11.0 shifts/month with an average of 25.4 hours and6.7 calls/shift. Thirty-two (9.1%) responding paramedics reported committing a medication error in the last 12 months. Types of errors included dose-related errors (63%), protocol errors (33%), wrong route errors (21%), andwrong medication errors (4%). Issues identified in contributing to the errors include failure to triple check, infrequent use of the medication, dosage calculation error, andincorrect dosage given. Fatigue, training, andequipment setup of the drug box were not listed as any of the contributing factors. The majority of these errors were self-reported to their CQI representative (79.1%), with 8.3% being reported by the base hospital radio nurse, 8.3% found upon chart review, and4.2% noted by paramedic during call but never reported. Conclusions. Nine percent of paramedics responding to an anonymous survey report medication errors in the last 12 months, with 4% of these errors never having been reported in the CQI process. Additional safeguards must continue to be implemented to decrease the incidence of medication errors.

Rediscovery and Recovery of the Ivory-Billed Woodpecker

Rediscovery and Recovery of the Ivory-Billed Woodpecker

How healthy are clones and their progeny: 5 years of field experience

There is considerable concern regarding the health of cloned cattle and their safety as a source of food. The objective was to summarize 5 years of commercial experience with cloning in three countries (United States, Argentina and Brazil). Overall, only 9% of transferred embryos resulted in calves; efficiency ranged from 0 to 45% (most were from 1 to 10%, but 24% of cell lines never produced live calves). There was no significant difference in pregnancy rate following transfer of one versus two embryos. Before 90 days of gestation, two ultrasound markers for embryo death were found, either crown rump length (CRL) or heart beat less than 7.5 mm and 150 bpm, respectively, were observed alone or together in 27% of clones that died. In addition, after 100 days of pregnancy, placental edema, hydrops fetalis and increased abdominal circumference size were used as ultrasound findings of a fetus at risk of loss. At 114 days of gestation, abdominal circumference in clones that died was statistically larger than in clones that survived alive to term and from MOET- and IVF-derived pregnancies ( P < 0.05). Since elective cesarean section (C-section) was partially replaced by natural or assisted parturition, C-section rates decreased from 100% in 2000 to 54% in 2005. On average, 42% of cloned calves died between delivery and 150 days of life; the most common abnormalities were: enlarged umbilical cord (37%), respiratory problems (19%), calves depressed/prolonged recumbency (20%) and contracted flexor tendons (21%). From 11 blood parameters evaluated during the first week of life, lactate decreased twice and glucose doubled its original value from 24 h to 7 days. Adult cloned females had normal breeding and calving rates and cloned bulls produced good quality semen and had normal fertility when used for AI or natural mating. In conclusion, cloning had no risks qualitatively different from those encountered in animals involved in modern agricultural practices, although the frequency of the risks appeared to be increased in cattle during the early portions of the life cycle of cattle clones.

An eight-year study report on arsenic contamination in groundwater and health effects in Eruani village, Bangladesh and an approach for its mitigation.

Based on several surveys during 1997-2005 and visits of a medical team to Eruani village, Laksham upazila, Comilla district, Bangladesh, the arsenic contamination situation and consequent clinical manifestations of arsenicosis among the villagers, including dermatology, neuropathy, and obstetric outcome, are reported here. Analysis of biological samples from patients and non-patients showed high body burden of arsenic. Even after eight years of known exposure, village children were still drinking arsenic-contaminated water, and many of them had arsenical skin lesions. There were social problems due to the symptoms of arsenicosis. The last survey established that there is a lack of proper awareness among villagers about different aspects of arsenic toxicity. The viability of different options of safe water, such as dugwells, deep tubewells, rainwater harvesting, and surface water with watershed management in the village, was studied. Finally, based on 19 years of field experience, it was felt that, for any successful mitigation programme, emphasis should be given to creating awareness among villagers about the arsenic problem, role of arsenic-free water, better nutrition from local fruits and vegetables, and, above all, active participation of women along with others in the struggle against the arsenic menace.

Characteristics of outstanding student teachers

This paper describes the characteristics of student teachers who were evaluated as outstanding during their teacher education studies. Outstanding students were selected after 2 years of field experiences based on their teaching abilities and academic achievements. Data were collected at three points of time: before they commenced their studies at the college, during the first 2 years of their studies and 4 years after completion of their studies. The study was conducted in two stages. The first compared three groups: (1) outstanding student teachers (22); (2) students with average achievements (55); (3) students who experienced difficulties (24). The comparison comprised the national psychometric test scores, high school matriculation examination grades, the written results of the acceptance interview and the evaluations of student teachers’ supervisors kept in each student's personal file. In the second stage, 4 years later, telephone interviews were conducted with 19 of the 22 students in the outstanding group and with 25 students from the same graduating class, who were chosen from a random sample of 75 students. Data analysis included descriptive statistics of means and standard deviations and one-way ANOVAs, to identify differences between the groups, and content analysis of the telephone interviews. Significant differences were found between the groups in their matriculation grades and in three parameters from the entrance committees’ reports: appearance, thinking and comments. Similarly, significant differences were found in the evaluations written by the supervisors in three categories: teaching ability, behaviour and social functioning. Four years later the prominent difference between the outstanding and the comparative groups was in the larger number of students from the outstanding group that continued with graduate studies towards a master's degree. All of the graduates in the outstanding group and most of the graduates in the comparative group performed additional tasks in school and had other employment outside school.

Paramedic Self-Reported Medication Errors

Background. Continuing quality improvement (CQI) reviews reflect that medication administration errors occur in the prehospital setting. These include errors involving dose, medication, route, concentration, andtreatment. Methods. A survey was given to paramedics in San Diego County. The survey tool was established based on previous literature reviews andquestions developed based on previous CQI data. Results. A total of 352 surveys were returned, with the paramedics reporting a mean of 8.5 years of field experience. They work an average of 11.0 shifts/month with an average shift length of 25.4 hours and6.7 calls/shift. Thirty-two responding paramedics (9.1%) reported committing a medication error in the past 12 months. Types of errors included dose-related errors (63%), protocol errors (33%), wrong route errors (21%), andwrong medication errors (4%). Issues identified in contributing to the errors include failure to triple check, infrequent use of the medication, dosage calculation error, andincorrect dosage given. Fatigue, training, andequipment setup of the drug box were not listed as any of the contributing factors. The majority of these errors were self-reported to their CQI representative (79.1%), with 8.3% reported by the base hospital radio nurse, 8.3% found on chart review, and4.2% noted by the paramedic during the call but never reported. Conclusions. Nine percent of paramedics responding to an anonymous survey reported medication errors in the past 12 months, with 4% of these errors never having been reported in the CQI process. Additional safeguards must continue to be implemented to decrease the incidence of medication errors.

Model-driven systems development

Traditional systems development methods are designed to create a point solution- that is, a solution for a specific and static set of requirements. These methods result in systems that are sluggish in their response to dynamic conditions and changing requirements, expensive to maintain over extended periods of time, and prone to system failure. As an alternative to this approach, this paper describes a model-driven approach to systems development, which extends traditional systems engineering methods and is well-suited to a systems development environment characterized by rapidly changing conditions and requirements. We describe how model-driven systems development is performed by using the RUP® SE (Rational Unified Process® for Systems Engineering) architecture framework and transformation methods, which have been refined over eight years of field experience by Rational®, IBM, and our clients.

Microfinance and HIV prevention – emerging lessons from rural South Africa

Do the gains in confidence and economic well being that can come from participation in a microfinance programme reduce clients' vulnerability to HIV infection? Until now practical experience and an evidence base relating to such activities have been limited. This article reviews the evidence supporting an enhanced role for microfinance in HIV prevention activities. It describes the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) – a South African case study that has been specifically designed to explore these relationships. The paper discusses the operational integration of microfinance and HIV prevention – highlighting challenges, emerging lessons and limitations in the light of international best practice and several years of field experience.

Artificial nest cavities for Amazona parrots

Artificial nest cavities for Amazona parrots

Communication from a Human Rights Perspective: Responding to the HIV/AIDS Pandemic in Eastern and Southern Africa

This paper focuses on one of the most critical issues of the international response to the HIV/AIDS pandemic and it certainly adds to the growing body of literature on approaches that attempt to move beyond behavior change communication-focused (BCC) interventions into more context-based dialogue-based approaches. The authors take into account some of the most relevant conceptual approaches and models that fueled the international debate around HIV/AIDS communication (i.e. Rockefeller Foundations Communication for Social Change; UNAIDS HIV/AIDS Communication Framework) and propose a Communication from a Human Rights Perspective Approach which reflects the human rights-based route undertaken by UNICEF over the past few years in the area of communications. The paper makes several important conceptual contributions. First it enriches the international debate on HIV/AIDS communication and the effectiveness of BCC in the context of HIV/AIDS. Second it brings into the academic literature an alternative communication approach based on years of field experience that responds to the growing HIV/AIDS pandemic. Third it puts community participation and ownership at the very center of the communications response to HIV/AIDS. Fourth it highlights the relevance of various community-based interventions to combat HIV/AIDS. (excerpt)

An evaluation of the risk for latex allergy in prehospital EMS providers

Hospital health care providers are increasingly being diagnosed as latex sensitive or allergic. Little is established on incidence or risks to prehospital health care providers. A written survey of EMT-DCs and EMT-Ps was done anonymously using established risk stratification questions to identify factors that indicate higher potential for developing latex allergies. There were 666 surveys distributed with 580 (87%) returned completed. Of the respondents, 533 were male (91%) with 510 (87%) reporting more than 5 years of field experience. Of the survey participants, 435 (75%) were EMT-DC level and 145 (25%) were EMT-P level. We found that latex sensitivities and allergies are present in our population, with an 8% incidence of latex allergies in EMT-DCs and 18% in EMT-Ps. A greater number of respondents report having factors that have been established to be associated with increased risk for latex allergies, indicating the need for more vigilant monitoring for the development of such reactions.

The Vanderbilt Fall Prevention Program for Long-Term Care: Eight Years of Field Experience with Nursing Home Staff

Fall prevention in nursing homes continues to be one of the most challenging aspects of care not only because of the high frequency of falls but also because of their significant impact on residents, families, staff, and administration. Between 45 to 70% of the estimated 1.7 million nursing home residents fall annually. Of these, 30 to 40% will fall two or more times and 11% will sustain a serious injury as a result of the fall. Consequences of falls can affect the resident through loss of function because of physical trauma as well as psychological trauma most often demonstrated by high levels of fear associated with falling. A common result of falls for medical and nursing staff is the need for increased levels of care provision due to resident changes in function. Increased paperwork and poor survey results are associated with a high incidence of falls as well. Falls also may negatively affect a facility’s relationship with families and the community. Finally, rising monetary awards associated with lawsuits related to falls and high insurance premiums may significantly increase operating costs of the facility. Settled claims vary widely between states with some awards exceeding $500,000. Hip fracture is one of the most serious consequences of falls. Over 300,000 hospitalizations among persons 65 years and older are due to hip fracture each year. Increased morbidity and mortality following hip fracture is well documented. Although patterns of excess deaths attributable to hip fracture vary with different levels of comorbidity and functionality at the time of fracture, an estimated 4 excess deaths per 100 hip fracture patients occur in the first year postfracture. Hip fracture often leads to severe losses in independence and quality of life, and of those able to ambulate independently before a fracture, fewer than one-half will be able to do so one year after the fracture. Multiple intrinsic and extrinsic fall risk factors have been identified in elderly nursing home residents. Intrinsic factors related to aging, acute medical illness, and chronic disease often cause sensory, cognitive, neurologic, and musculoskeletal impairments that have been shown to increase fall risk. About one-half of the residents in nursing homes exhibit some form of dementia, and as a result, unsafe behaviors due to cognitive loss are extremely common. Evidence suggests that residents with dementia have a higher risk of falls and associated injuries. Side effects of many medications have also been shown to increase fall risk in the elderly. In particular, antipsychotics, hypnotic-anxiolytics with long elimination half-lives, and cyclic antidepressants are associated with a significantly higher fall risk. Extrinsic factors in relation to the environment and equipment such as clutter, poor lighting, uneven flooring, and ineffective wheelchair brakes also affect fall risk. As the number of persons residing in nursing homes increases due to the greater life expectancy of persons reaching 65 years of age and the level of care rises due to increases in disability, reduction of falls will continue to be a major public health problem. Although fall prevention efforts for community-dwelling elderly have reported some success, few studies are available in the nursing home population. For this reason, in 1993 the Vanderbilt University Department of Preventive Medicine developed its first fall prevention program to determine its efficacy in long term care. The Vanderbilt Fall Prevention Program includes comprehensive assessment and individualized care plan development for residents who are at high risk of falling as well as inspection and repair of safety problems in the resident’s environment and with equipment. The program is implemented by a multi-disciplinary team and includes training of all facility staff in fall prevention methods. This article describes progression of the Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.

The Vanderbilt Fall Prevention Program

Minimizing falls and injuries in long-term care is a shared goal of the administration, nursing staff, medical directors, and state surveyors. Risks for injuries have been well documented in the past decade. The article by Taylor 1 Taylor JA The Vanderbilt Fall Prevention Program for Long-Term Care: Eight years of Field Experience with Nursing Home Staff. J Am Med Dir Assoc. 2002; 3: 180-185 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar describes the efforts of an academic team to reduce falls and injuries in the state of Tennessee. The report of this team is a model for other academic health centers to move beyond publishing studies to actually improving care in the real world of long-term care.

The Vanderbilt Fall Prevention Program for Long-Term Care: Eight Years of Field Experience with Nursing Home Staff

The Vanderbilt Fall Prevention Program for Long-Term Care: Eight Years of Field Experience with Nursing Home Staff

Aggregate Blending for Asphalt Mix Design: Bailey Method

From the beginning of asphalt mixture design it was desired to understand the interaction of aggregates, asphalt, and the voids created during their compaction. In asphalt mixture design, guidance is lacking in the selection of the design aggregate structure and understanding the interaction of that aggregate structure and mixture volumetric properties. Asphalt mixture design concepts are presented that use aggregate interlock and aggregate packing to develop an aggregate blend that meets volumetric criteria and provides adequate compaction characteristics. The concepts rely on coarse aggregate for the skeleton of the mixture with the proper amount of fine aggregate to provide a properly packed aggregate structure. The objective is to use aggregate packing concepts to analyze the combined gradation and relate the packing characteristics to the mixture volumetric properties and compaction characteristics. The new concepts presented for asphalt mixture design and analysis include an examination of aggregate packing and aggregate interlock, blending aggregates by volume, a new understanding of coarse and fine aggregate, and analysis of the resulting gradation. These concepts are the result of many years of field experience and are the backbone of the Bailey method for asphalt mix design. These methods are under continued development as the improved method for asphalt mixture design, which will assist with the transition to contractor mix design.

Effect of Solution Gas in Oil on CO2 Minimum Miscibility Pressure

Abstract In this study, a rising bubble apparatus (RBA) was used to determine the CO2 MMP for various oils. RBA tests permit direct observation of changes in bubble behaviour and thus offered insight into the phase behaviour for the CO2-reservoir fluid system. The CO2 MMPs were estimated for two Steelman reservoir fluids with a high gas-oil ratio, the partially flashed reservoir fluids, and the dead oils. The composition of solution gas of each partially flashed reservoir fluid was determined and the effects of different gas components were analysed. The MMP was also determined and discussed for Weyburn reservoir fluids which had a low gas-oil ratio with pure and impure CO2. The results of this study demonstrated that the effect of solution gas in oil on CO2 MP could be significant. Furthermore, achieving a miscible CO2 flood (in a reservoir with a Steelman-like reservoir fluid) could be possible at a lower operating pressure than the measured CO2 MMP, by partially depleting the reservoir. This may be the only option for some reservoirs which cannot sustain the relatively high pressure required for achieving miscibility. Introduction Carbon dioxide flooding is a proven oil recovery process(1). Over the last decade, carbon dioxide injection has become the leading enhanced oil recovery (EOR) process for light oils(2). CO2 injection can prolong, by 15 to 20 years, the production life of light oil fields nearing depletion under waterflood, and may recover 15 to 25% of the original oil in place. More than 20 years of field experience of CO2 injection has advanced the CO2 technology. CO2 injection can be introduced gradually and use some of the same equipment currently in place for waterflooding. Saskatchewan's light and medium oil resource, representing nearly 45% of proven reserves, has been on waterflood for over 30 years and is fast approaching its economic limit of production(3). For the light and medium oil reservoirs in Saskatchewan, carbon dioxide or hydrocarbon injection is considered to be the most effective EOR process(4–6). These gases can be injected into the reservoir to develop miscible or immiscible conditions with the oil depending upon the operating pressure. Carbon dioxide is preferred over hydrocarbon gases (e.g., ethane, propane) because it is cheaper, has higher density, and offers environmental benefits by providing storage for CO2 in the reservoir. The Saskatchewan Research Council (SRC) is conducting a comprehensive research program to assess the suitability of miscible CO2 displacement for reservoirs in southeast Saskatchewan and to optimize the field operating procedures. The first step in determining if a field is a viable CO2 flood candidate is to conduct a screening study to provide a reasonable estimate of CO2 injection performance. The minimum miscibility pressure (MMP) is a key parameter used in the assessment. It has been recognized that the CO2 MMP for a reservoir oil depends on the reservoir temperature, oil composition, and the purity of injected CO2. The minimum miscibility pressure increases with increasing reservoir temperature.

Conducting focus groups in developing countries: skill training for local bilingual facilitators.

Many countries of the world are characterized by the use of two or more languages, and qualitative research is usually conducted in indigenous languages; however, bilingual facilitators often do not have any experience in research studies or in conducting focus group discussions. This article presents a 4-day skill-training workshop for local facilitators in which they learn the role of moderator, recorder, and observer and acquire research skills during role playing and during a pretest of the study population. Developed over several years of field experience, this technique has proven successful in collecting reliable data in situations when time is limited, when participants speak indigenous languages, and when bilingual facilitators have no background in research and lack focus group skills. The advantages of this training are that it is low cost and fast and permits a careful translation of the data. Moreover, because facilitators are involved in the collecting and analyzing of the data, their input provides the investigator with a valuable understanding of the findings from an emic perspective.