Determining Unmet Needs Among Workers' Compensation Stakeholders to Prevent Work Disability in the State of Vermont.

Purpose: Vermont has high rates of young people receiving federal disability benefits leading to substantial gaps in the workforce. The purpose of this project was to determine the unmet needs of interested parties in the workers' compensation (WC) process.

Methods: A type of focus group, experience groups, was used to elicit key parties' experiences in the WC system.

What is the best design approach for estimating effluent concentrations from horizontal flow treatment wetlands: the use of volumetric (k) or areal (k) removal rate coefficients?

Effluent concentrations from horizontal flow (HF) treatment wetlands can be estimated by using the Tanks-In-Series model for describing hydraulics and first-order removal rate coefficients for describing pollutant removal. In the design of conventional wastewater treatment plants, volumetric removal rate coefficients (k) are traditionally used in conjunction with the theoretical hydraulic retention time. Areal removal rate coefficients (k) coupled with the applied areal hydraulic loading rate are widely used in the literature.

Evaluating variation in pre-operative evaluation and planning for children undergoing atrial or ventricular septal defect repair.

Background: CHD care is resource-intensive. Unwarranted variation in care may increase cost and result in poorer health outcomes. We hypothesise that process variation exists within the pre-operative evaluation and planning process for children undergoing repair of atrial septal defect or ventricular septal defect and that substantial variation occurs in a small number of care points.

What is the best procedure for determining removal rate coefficients in horizontal flow treatment wetlands: influent and effluent concentrations or longitudinal concentration profiles?

First-order removal rate coefficients (k) are used in predictive equations for estimating effluent concentrations from horizontal flow (HF) wetlands. Due to limited resources, influent and effluent concentration data from existing systems are frequently used in the estimation of k values from operating systems, but another choice is to use concentration data along the longitudinal profile of the HF wetland. Based on a dataset with 41 HF wetlands/studies obtained from a literature survey, with chemical oxygen demand (COD) measurements at different sampling points, volumetric (k) and areal (k) removal rate coefficients for the Tanks-In-Series (TIS) model have been obtained using the two estimation methods.

A Model for Evaluating Total Costs of Care and Cost Savings of Specialty Condition-Based Care for Hip and Knee Osteoarthritis in an Integrated Practice Unit.

Objectives: The viability of specialty condition-based care via integrated practice units (IPUs) requires a comprehensive understanding of total costs of care. Our primary objective was to introduce a model to evaluate costs and potential costs savings using time-driven activity-based costing comparing IPU-based nonoperative management with traditional nonoperative management and IPU-based operative management with traditional operative management for hip and knee osteoarthritis (OA). Secondarily, we assess drivers of incremental cost differences between IPU-based care and traditional care.

Senior Aviator Medical Qualification Status.

Introduction: Aviation personnel are expensive to train and challenging for the services to retain because of lucrative opportunities in the civilian aviation sector and a desire among pilots for agency. The military services' retention efforts have typically utilized a combination of high continuation pays and longer service commitments of up to 10 years following initial training. One area that the services have overlooked in their attempts to retain senior aviators is quantifying and reducing medical disqualifications.

Examining the Real-Life Journey of Individuals and Families Affected by Single-Ventricle Congenital Heart Disease.

Background The lifetime journey of patients with single-ventricle congenital heart disease is characterized by long-term challenges that are incompletely understood and still unfolding. Health care redesign requires a thorough understanding of this journey to create and implement solutions that improve outcomes. This study maps the lifetime journey of individuals with single-ventricle congenital heart disease and their families, identifies the most meaningful outcomes to them, and defines significant challenges in the journey.

Peaks, pores, and dragon eggs: Uncovering and quantifying the heterogeneity of treatment wetland biofilm matrices.

Biofilms serve to house diverse microbial communities, which are responsible for the majority of wastewater constituent degradation and transformation in treatment wetlands (TWs). TW biofilm has been generally conceptualized as a relatively uniform film covering available surfaces. However, no studies attaining direct visual 3D representations of biofilm morphology have been conducted.

Evapotranspiration dynamics in aerated and non-aerated subsurface flow treatment wetlands.

This study reports the seasonal dynamics of evapotranspiration (ET) and evaporation (E) in different subsurface flow treatment wetlands operating in a temperate European climate. Daily water balances were compiled over the course of ten years (August 2010-July 2020). The study includes non-aerated horizontal flow wetlands (25 cm deep and 50 cm deep) as well as horizontal flow and vertical flow wetlands.

On Protection of U.S. Forces From Global Health Threats: The Role of Health Security Advisors.

The coronavirus disease 2019 pandemic has exposed a health security gap within our nation and around the world. Recent national laws and policies have outlined the ends and means to improve health security. A decisive way is to achieve this objective is through health-related security cooperation efforts by increasing Health Services Support capacity.

What are People That Seek Care for Rotator Cuff Tendinopathy Experiencing in Their Daily Life?

This qualitative study sought to answer three questions: What is it like to live with rotator cuff tendinopathy? What are the barriers and facilitators of a healthy lifestyle with an aging shoulder? And, what are the outcomes that matter most to people seeking care for rotator cuff tendinopathy? Patients diagnosed with rotator cuff tendinopathy participated in group discussions using semi-structured guides that focus on diagnosis, daily experiences living with rotator cuff tendinopathy, goals, concerns, and clinical care experiences. A hybrid of initial inductive coding of themes and subsequent deductive consideration of these themes within the capability, comfort, and calm framework was utilized. Themes associated with rotator cuff tendinopathy were less restful sleep, difficulty with work and life transitions, loss of baseline abilities, and limitation in social roles in the capability realm; physical pain, despair, and loneliness in the comfort realm; and lack of direction or progress and feeling uncared for in the calm realm.

The role and value of science in shark conservation advocacy.

Many species of sharks are threatened with extinction, and there has been a longstanding debate in scientific and environmental circles over the most effective and appropriate strategy to conserve and protect them. Should we allow for sustainable fisheries exploitation of species which can withstand fishing pressure, or ban all fisheries for sharks and trade in shark products? In the developing world, exploitation of fisheries resources can be essential to food security and poverty alleviation, and global management efforts are typically focused on sustainably maximizing economic benefits. This approach aligns with traditional fisheries management and the perspectives of most surveyed scientific researchers who study sharks.

Hydraulic characterization and removal of metals and nutrients in an aerated horizontal subsurface flow "racetrack" wetland treating primary-treated oil industry effluent.

Constructed wetlands (CW) are an attractive technology due to their operational simplicity and low life-cycle cost. It has been applied for refinery effluent treatment but mostly single-stage designs (e.g.

Ethical Considerations for Surgical Planners from the Lessons Learned on USNS COMFORT (T-AH 20) Deployment 2019.

Ethical issues can arise when planning for direct patient care surgical missions. Based on the lessons learned from the USNS COMFORT Deployment 2019, the authors present concise considerations and recommendations for future hospital ship surgical mission planning.

Spontaneous Vitreous Hemorrhage in a Naval Aviator.

Spontaneous vitreous hemorrhage is uncommon in the general population. Of cases, 1020% are idiopathic or due to occult causes and a majority of the remainder are associated with diabetic disease. The evaluation and disposition of an aviator has not been reported previously.

Outcomes That Matter Most to Young Adults Diagnosed with Cancer: A Qualitative Study.

The purpose of this study is to provide insight for improvement in care for young adults diagnosed with cancer (YADC), by identifying underemphasized outcomes that strongly matter to YADC and the gaps in care that may limit achieving these outcomes for this unique and vulnerable population. Twenty-seven YADC, ages 25-39, participated in unstructured discussions focusing on topics relating to diagnosis, daily experiences living with cancer outside of the clinical setting, goals, concerns, and clinical care experience. Most participants engaged in group discussions using Experience Group methodology.

A review of emerging organic contaminants (EOCs), antibiotic resistant bacteria (ARB), and antibiotic resistance genes (ARGs) in the environment: Increasing removal with wetlands and reducing environmental impacts.

Emerging organic contaminants (EOCs) include a diverse group of chemical compounds, such as pharmaceuticals and personal care products (PPCPs), pesticides, hormones, surfactants, flame retardants and plasticizers. Many of these compounds are not significantly removed in conventional wastewater treatment plants and are discharged to the environment, presenting an increasing threat to both humans and natural ecosystems. Recently, antibiotics have received considerable attention due to growing microbial antibiotic-resistance in the environment.

Defining and Implementing Value-Based Health Care: A Strategic Framework.

Value in health care is the measured improvement in a person's health outcomes for the cost of achieving that improvement. While some descriptions conflate value-based health care and cost reduction, quality improvement, or patient satisfaction, those efforts-while important-are not the same as value, which focuses primarily on improving patient health outcomes. A decade of research into organizations that have achieved better outcomes while often lowering costs suggests a strategic framework for value-based health care implementation that starts with identifying and understanding a segment of patients whose health and related circumstances create a consistent set of needs.

Side-by-side comparison of 15 pilot-scale conventional and intensified subsurface flow wetlands for treatment of domestic wastewater.

This study reports a systematic assessment of treatment efficacy for 15 pilot-scale subsurface flow constructed wetlands of different designs for CBOD, TSS, TOC, TN, NH-N, NO-N, NO-N, and E. coli over the course of one year in an outdoor study to evaluate the effects of design and plants. The systems consisted of a range of designs: horizontal flow (HF) with 50 and 25 cm depth, unsaturated vertical flow (VF) with sand or fine gravel, and intensified systems (horizontal and saturated vertical flow with aeration, and reciprocating fill and drain).

Conjoint Analysis of Treatment Preferences for Nondisplaced Scaphoid Fractures.

Purpose: We used conjoint analysis to assess the relative importance of factors that influence a patient's decision between surgical or nonsurgical management of a nondisplaced scaphoid fracture. Our hypothesis was that out-of-pocket costs will have a greater influence on decision making than the time spent in a cast or brace, degree of soreness, or the risk of treatment failure.

Methods: Two-hundred and fifty participants were recruited using Amazon Mechanical Turk and asked to assume that they had experienced a nondisplaced scaphoid waist fracture.

Pyogenic Pericarditis and Cardiac Tamponade Due to in a Combat Theater.

group pericarditis is rare. A 24-year-old male soldier presented for care at a military clinic in Afghanistan with shock and cardiac tamponade requiring emergent pericardial drainage and aeromedical evacuation. We review the patient's case, the need for serial pericardial drainage, and the available literature on this disorder.