To achieve the federal outcomes of the Child and Family Services Review with limited budgets, program evaluation of strategies such as family preservation programs (FPP) is necessary. This naturalistic state-level study compared 1,510 families and 3,229 children served by FPP to non-served families. Cost avoidance was calculated on out-of-home care (OOHC) diversion rates. FPP-served families had high risks, young children, and repeated child welfare involvement. FPP was associated with fewer and shorter stays in OOHC, higher reunification rates, and more placement stability. The FPP-served families showed a recurrent pattern of need, suggesting the need to develop alternative intervention protocols.
The purpose of the study was to assess patient and clinician perceptions of prediabetes in an academic family medicine practice. Data were collected in preparation for an implementation study to increase utilization of the National Diabetes Prevention Program (N-DPP). Methods In this mixed-methods study, discussions from 3 focus groups composed of patients with prediabetes were evaluated using thematic analysis for their understanding of and beliefs about prediabetes, care experiences, and attitudes toward N-DPP. Clinicians completed a Likertscaled survey assessing attitudes and perceived barriers to providing prediabetes care. Results Among the 15 focus group participants, more than half were not aware of their diagnosis. Attitudes toward prediabetes were mixed: while many believed it was serious and elicited more fear than being "at risk," others thought there were varying degrees of risk within the same diagnosis, making the diagnosis less impactful. Patients repeatedly expressed the perception that clinicians were not forthcoming about necessary behavior changes. Patients agreed on barriers to N-DPP, including scheduling and transportation. Clinicians (N = 31) concurred that patients lack awareness of their prediabetes diagnosis. They reported that time is available to screen all patients and that a prediabetes diagnosis is effective for advising patients of the need for lifestyle modification. There was 845347T DEXXX10.
This paper presents a new approach to characterize nanoparticles using derivatives of scattering profiles of evanescent waves/surface plasmons. We start the procedure using the scattering profiles for an unknown configuration of nanoparticles, either from physical experiments or numerical simulations conducted for different nanoparticles on surfaces. We apply the statistical technique of compound estimation to recover the derivatives of scattering profiles. The L(1) discrepancies with the corresponding curves from known configurations are used to identify the most plausible configuration of particles that could yield the "experimental" profiles. We conduct a simulation study to see how often the new procedure correctly recovers the agglomeration level for gold spherical nanoparticles on a thin gold film. The results suggest that first derivatives are much more effective for characterization than undifferentiated profiles and that M(33) is the most useful element for distinguishing among configurations. The proposed compound estimation technique is more effective than typical inverse analyses based on look-up tables and can be used effectively in nanoparticle characterization platforms.
Background and Objectives: According to a previous study, obstetric deliveries may be protective against burnout for family physicians. Analyses of interviews conducted during a larger qualitative study about the experiences of early-career family physicians who intended to include obstetric deliveries in their practice revealed that many interviewees discussed burnout. This study aimed to understand the relationship between practicing obstetrics and burnout based on an analysis of these emerging data on burnout. Methods: We conducted semistructured interviews with physicians who graduated from family medicine residency programs in the United States between 2013 and 2016. We applied an immersion-crystallization approach to analyze transcribed interviews. Results: Fifty-six early-career family physicians participated in interviews. Burnout was an emerging theme. Physicians described how practicing obstetrics can protect from burnout (eg, brings joy to practice, diversity in practice), how it can contribute to burnout (eg, time demands, increased stress), how it can do both simultaneously and the importance of professional agency (ie, the capacity to make own free choices), and other sources of burnout (eg, administrative tasks, complex patients). Conclusions: This study identifies a family medicine-obstetric paradox wherein obstetrics can simultaneously protect from and contribute to burnout for family physicians. Professional agency may partially explain this paradox.
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