The Impact of Regionalization of Pancreaticoduodenectomy for Pancreatic Cancer in North Carolina since 2004

2014 ◽  
Vol 80 (6) ◽  
pp. 561-566 ◽  
Author(s):  
Ryan Z. Swan ◽  
David J. Niemeyer ◽  
Ramanathan M. Seshadri ◽  
Kyle J. Thompson ◽  
Amanda Walters ◽  
...  
Keyword(s):  
North Carolina ◽  
Significant Risk ◽  
High Volume ◽  
Major Morbidity ◽  
The North ◽  
Time Period ◽  
Improved Outcomes ◽  
Before And After ◽  
Low Volume ◽  
The Impact

Pancreaticoduodenectomy (PD) carries a significant risk. High-volume centers (HVCs) provide improved outcomes and regionalization is advocated. Rapid regionalization could, however, have detrimental effects. North Carolina has multiple HVCs, including an additional HVC added in late 2006. We investigated regionalization of PD and its effects before, and after, the establishment of this fourth HVC. The North Carolina Hospital Discharge Database was queried for all PDs performed during 2004 to 2006 and 2007 to 2009. Hospitals were categorized by PD volume as: low (one to nine/year), medium (10 to 19/year), and high (20/year or more). Mortality and major morbidity was assessed by comparing volume groups across time periods. Number of PDs for cancer increased 91 per cent (129 to 246 cases) at HVCs, whereas decreasing at low-volume (62 to 58 cases) and medium-volume (80 to 46 cases) centers. Percentage of PD for cancer performed at HVCs increased significantly (47.6 to 70.3%) while decreasing for low- and medium-volume centers ( P < 0.001). Mortality was significantly less at HVCs (2.8%) compared with low-volume centers (10.3%) for 2007 to 2009. Odds ratio for mortality was significantly lower at HVCs during 2004 to 2006 (0.31) and 2007 to 2009 (0.34). Mortality for PD performed for cancer decreased from 6.6 to 4.6 per cent ( P = 0.31). Major morbidity was not significantly different between groups within either time period; however, there was a significant increase in major morbidity at low-volume centers ( P = 0.018). Regionalization of PD for cancer is occurring in North Carolina. Mortality was significantly lower at HVCs, and rapid regionalization has not detracted from the superior outcomes at HVCs.

An Investigation into the Impact of Environmental Education Certification on Perceptions of Personal Teaching Efficacy

2017 ◽  
Vol 22 (2) ◽  
pp. 5-17
Author(s):  
Mandy Harrison ◽  
Lisa Gross ◽  
Jennifer McGee
Keyword(s):  
North Carolina ◽  
Environmental Education ◽  
Self Efficacy ◽  
Teaching Efficacy ◽  
School Teachers ◽  
The North ◽  
Significant Difference ◽  
Personal Teaching Efficacy ◽  
Environmental Educators ◽  
The Impact

The purpose of this study is to examine how participation in the North Carolina Environmental Educator (NCEE) program influences the individual's perceived self-efficacy. Specifically, this study examines the impact of NCEE certification on participants’ perceived personal teaching self-efficacy. This study compared personal teaching efficacy scores of certified environmental educators, non-certified environmental educators, and licensed schoolteachers. The study found significant differences in teaching efficacy between certified and non-certified environmental educators, as well as certified environmental educators and licensed school teachers. In addition, the study found no significant difference in efficacy scores between NCEE certified licensed school teachers and NCEE certified environmental educators. Results of this study indicate a link between environmental education certification and higher personal teaching efficacy.

The storm after the storm: the long-term lingering impacts of hurricanes on schools

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Cassandra R. Davis ◽  
Sarah R. Cannon ◽  
Sarah C. Fuller
Keyword(s):  
North Carolina ◽  
Data Collection ◽  
Instructional Time ◽  
Emotional Needs ◽  
Social Emotional ◽  
Content Type ◽  
The North ◽  
State Education ◽  
The Impact

PurposeThe purpose of this paper is to identify and describe the long-term impacts of hurricanes on schools and discuss approaches to improving recovery efforts.Design/methodology/approachInterviews with 20 school districts in Texas and North Carolina after Hurricanes Harvey (2017) and Matthew (2016). In total, 115 interviews were conducted with teachers, principals, district superintendents and representatives from state education agencies. Interview questions focused on the impact of storms and strategies for recovery.FindingsThe authors uncovered three long-term impacts of hurricanes on schools: (1) constrained instructional time, (2) increased social-emotional needs and (3) the need to support educators.Research limitations/implicationsThis paper focuses on two storms, in two states, in two successive years. Data collection occurred in Texas, one academic year after the storm. As compared to the North Carolina, data collection occurred almost two academic years after the storm.Practical implicationsThis paper illuminates strategies for stakeholders to implement and expedite hurricane recovery through; (1) updating curricula plans, (2) providing long-term counselors and (3) supporting educators in and out of school.Originality/valueTo date, very few studies have explored the ways in which schools face long-term impacts following a disaster. This paper provides insight to the challenges that prolong the impacts of disasters and impede recovery in schools. With hurricanes and related disasters continuing to affect schooling communities, more research is needed to identify the best ways to support schools, months to years after an event.

scholarly journals The Effect of Disclosure and Transparency Criteria In Saudi Banks on The Financial Ratios Indicators

2019 ◽  
Vol 25 (116) ◽  
pp. 290-303
Author(s):  
Mohammad Kamal Kamel Afaneh
Keyword(s):  
Performance Indicators ◽  
Banking Sector ◽  
Saudi Arabian ◽  
Financial Statements ◽  
Monetary Authority ◽  
Financial Indicators ◽  
Return On Assets ◽  
Time Period ◽  
Before And After ◽  
The Impact

The study aimed to measure the effect of applying the disclosure and transparency standards criteria adopted by the Saudi Arabian Monetary Authority on improving performance indicators in the Saudi banking sector, by measuring the extent of the impact of the bank's financial indicators represented by liquidity, profitability and return on assets in Saudi banks by applying the criteria of disclosure and transparency, which is one of the Main principles in the list of governance, which was approved by the Saudi Arabian Monetary Authority. The analytical approach was followed to achieve the goal of the study, as the financial statements of Saudi banks were analyzed during a period of 8-year to test four hypotheses related to measuring the presence of statistically significant differences between the performance indicators of banks before and after applying the disclosure and transparency standards imposed on Saudi banks. The results of the research confirmed the existence of an inverse relationship between the bank’s liquidity and the percentage of Saudi banks ’profits. The more liquidity, the lower the profitability level of banks, which indicates that the high liquidity in Saudi banks has led to a low profitability in this time period, and the study recommended that The need to pay attention to the concept of disclosure and transparency among all related parties in Saudi banks, and banks should find a balance between liquidity and profitability  

scholarly journals The Impact of Wolf Reintroduction on the Foraging Efficency of Elk and Bison

1998 ◽  
Vol 22 ◽  
pp. 48-52
Author(s):  
John Laundre
Keyword(s):  
Predation Risk ◽  
National Parks ◽  
Cervus Elaphus ◽  
The North ◽  
Safety Research ◽  
Conflicting Demands ◽  
Before And After ◽  
Quality Diet ◽  
Long Term Impact ◽  
The Impact

More and more, evidence indicates that non­lethal interactions between large mammalian ungulates and the predators that feed on them may play significant roles in ungulate population dynamics. Although predators such as wolves and mountain lions directly impact large ungulates like elk (Cervus elaphus) when they kill individuals, the fact that they scare their prey may actually have a greater long term impact on the population (Kotler and Hoyt 1989, Brown 1992, Brown and Alkon 1990 Brown et al. 1999). In response to predation risk, foraging animals are found balancing conflicting demands for food and safety. Research indicates they do this by two principal means: 1) when faced with higher predation risk, prey individuals will reduce feeding effort and/or increase vigilance compared to areas of lower risk (Sih 1980, Lima and Dill 1990), 2) they alter their use of habitat types to help reduce this predation risk. The major result is that reduced feeding efforts or selection of safer but possibly less productive habitat lead to a third prediction of a poorer quality diet as animals seek out safer areas but with likely lower quality forage. The reintroduction of wolves in Yellowstone National Parks offered a unique opportunity to test the impact of wolves on the feeding efficiency of elk and bison. After the wolves were reintroduced into Yellowstone Park in the spring of 1995, they quickly established themselves in specific locations, specifically in the Lamar Valley in the north end of the Park. This allowed us to collect data on areas with and without wolves for the first few years after their release. Additionally, as wolves have expanded their range in the Park, this has also provided an excellent opportunity to compare data on animals from the same areas before and after wolves have arrived. These comparisons then, would provide a critical test of the predictions that large predators can have a major non-lethal impact on their prey. To test these predictions, in 1996 we began a study of the foraging patterns of elk and bison in Yellowstone National Park. Here we report the results of the first four years of this study.

scholarly journals A Data Driven Change-point Epidemic Model for Assessing the Impact of Large Gathering and Subsequent Movement Control Order on COVID-19 Spread in Malaysia

2020 ◽  
Author(s):  
Sarat C. Dass ◽  
Wai M. Kwok ◽  
Gavin J. Gibson ◽  
Balvinder S. Gill ◽  
Bala M. Sundram ◽  
...  
Keyword(s):  
Change Point ◽  
Movement Control ◽  
Disease Spread ◽  
Time Period ◽  
Before And After ◽  
Quantitative Understanding ◽  
Control Order ◽  
Short Time ◽  
The Impact ◽  
Second Wave

AbstractThe second wave of COVID-19 in Malaysia is largely attributed to a mass gathering held in Sri Petaling between February 27, 2020 and March 1, 2020, which contributed to an exponential rise of COVID-19 cases in the country. Starting March 18, 2020, the Malaysian government introduced four consecutive phases of a Movement Control Order (MCO) to stem the spread of COVID-19. The MCO was implemented through various non-pharmaceutical interventions (NPIs). The reported number of cases reached its peak by the first week of April and then started to reduce, hence proving the effectiveness of the MCO. To gain a quantitative understanding of the effect of MCO on the dynamics of COVID-19, this paper develops a class of mathematical models to capture the disease spread before and after MCO implementation in Malaysia. A heterogeneous variant of the Susceptible-Exposed-Infected-Recovered (SEIR) model is developed with additional compartments for asymptomatic transmission. Further, a change-point is incorporated to model the before and after disease dynamics, and is inferred based on data. Related statistical analyses for inference are developed in a Bayesian framework and are able to provide quantitative assessments of (1) the impact of the Sri Petaling gathering, and (2) the extent of decreasing transmission during the MCO period. The analysis here also quantitatively demonstrates how quickly transmission rates fall under effective NPI implemention within a short time period.

The Impact of Prescribed Burning on Native Bee Communities (Hymenoptera: Apoidea: Anthophila) in Longleaf Pine Savannas in the North Carolina Sandhills

2019 ◽  
Vol 49 (1) ◽  
pp. 211-219
Author(s):  
Heather Moylett ◽  
Elsa Youngsteadt ◽  
Clyde Sorenson
Keyword(s):  
North Carolina ◽  
Prescribed Burning ◽  
Longleaf Pine ◽  
Pinus Palustris ◽  
The North ◽  
Time Since Fire ◽  
Native Bee ◽  
Silvicultural Practice ◽  
Bee Community ◽  
The Impact

Abstract Prescribed burning is a common silvicultural practice used in the management of longleaf pine (Pinus palustris Mill., Pinales: Pinaceae) savannas to reduce hardwood encroachment and ground cover and to maintain biodiversity. We investigated the response of the native bee community (Hymenoptera: Apoidea: Anthophila) in the Sandhills of North Carolina to prescribed burning on a 3-yr rotation over two consecutive years (2012 and 2013). We deployed bee bowl traps in sites that had been burned the year of sampling, 1 yr before, 2 yr before, and in unburned controls. In total, 2,276 bees of 109 species were captured. Bee abundance declined with time since fire, with 2.3 times more bees captured in the most recently burned sites than in unburned controls. Bee diversity also declined with time since fire, with 2.1 times more species captured in the most recently burned sites than in controls. Bee community composition also responded to fire; we present evidence that this response was mediated in part by the effect of fire on the amount of bare ground and canopy cover. Bees nesting aboveground were unaffected by fire, contrary to our expectation that fire would destroy the wood and stems in which these species nest. Our results indicate that prescribed burning is a silvicultural practice consistent with pollinator conservation in longleaf pine ecosystems of the North Carolina sandhills.

scholarly journals Analysis and Optimization of a Combined Make-to-Stock and Make-to-Order Multiproduct Manufacturing System

2009 ◽  
Vol 2009 ◽  
pp. 1-27 ◽  
Author(s):  
Khaled Hadj Youssef ◽  
Christian van Delft ◽  
Yves Dallery
Keyword(s):  
Lead Time ◽  
High Volume ◽  
Service Level ◽  
Time Service ◽  
Inventory Costs ◽  
Make To Order ◽  
End Products ◽  
Low Volume ◽  
Multiproduct Manufacturing ◽  
The Impact

We consider a single-stage multiproduct manufacturing facility producing several end-products for delivery to customers with a required customer lead-time. The end-products can be split in two classes: few products with high volume demands and a large number of products with low-volume demands. In order to reduce inventory costs, it seems efficient to produce the high-volume products according to an MTS policy and the low volume products according to an MTO policy. The purpose of this paper is to analyze and compare the impact of the scheduling policy on the overall inventory costs, under customer lead-time service level constraints. We consider two policies: the classical FIFO policy and a priority policy (PR) which gives priority to low volume products over high volume products. We show that for some range of parameters, the PR rule can significantly outperform the FIFO rule. In these ranges, the service level constraints are satisfied by the PR rule with much lower inventory costs.

On Partnering and Tourism: A Comparison of Two Small Towns in Western North Carolina

2005 ◽  
Vol 27 (4) ◽  
pp. 19-21
Author(s):  
Molly Levin
Keyword(s):  
North Carolina ◽  
Small Towns ◽  
Partnership Model ◽  
The North ◽  
Development Organizations ◽  
Western North Carolina ◽  
Community Development Organizations ◽  
Ethnographic Data ◽  
The Impact

Many community development organizations seek to involve their clients in projects through partnerships. This paper addresses the partnership model of the North Carolina-based organization HandMade in America and its Small Towns Revitalization Program. Ethnography plays an important role in this investigation. I spent the summer of 2004 as an intern at HandMade in America (HandMade), collecting ethnographic data in order to create a survey measuring the impact that the Small Towns program is having on the quality of residents' lives. While sitting in numerous living rooms and kitchens talking with men and women, old and young, local and newcomer, it became clear that while there are similarities across the region, each town has its own resources and problems that dictate the concerns of its residents.

Variation in the use of intensity-modulated radiation therapy (IMRT) in the state of Michigan: 2005-2010.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 219-219 ◽  
Author(s):  
James Hayman ◽  
Kent A. Griffith ◽  
Reshma Jagsi ◽  
Mary Uan-Sian Feng ◽  
Jean M. Moran ◽  
...  
Keyword(s):  
Radiation Oncology ◽  
Repeated Measures ◽  
Intensity Modulated Radiation Therapy ◽  
High Volume ◽  
Freedom Of Information ◽  
External Beam ◽  
Improved Outcomes ◽  
Primary Driver ◽  
Low Volume ◽  
Reported Data

219 Background: Interest is growing in value in health care, defined as better outcomes at lower costs. A primary driver of cost in radiation oncology is the use of IMRT. We examined the patterns and correlates of use of IMRT across Michigan using publicly available data. Methods: As a certificate of need state, Michigan requires every radiation oncology facility to report yearly the number of external beam and IMRT treatments delivered. Data for 2005-2008 were obtained through a Freedom of Information Act request of the Michigan Department of Community Health, while 2009-2010 data were available at its website. Percentage of external beam treatments delivered using IMRT (IMRT%) was examined across centers over time and repeated-measures longitudinal linear regression was used to identify factors associated with use. Results: During 2005-2010, 48 to 65 centers reported data. Median IMRT% (range) rose steadily during the study period: 2005 16% (0-64); 2006 21% (0-57); 2007 27% (0-79); 2008 37% (7-85); 2009 41% (0-87) 2010 45% (7-100). There was also significant between-center variation (see table). Regression modeling demonstrated that IMRT% was associated with year (+6.7% per year, p<0.0001), facility type (+7.1% freestanding versus hospital, p<0.11), facility annual volume (+5.0% high volume: 7,000+ versus low: <7,000, p=0.01) and the interaction between year and volume (low volume +2.4% per year versus high volume p<0.02). The significant interaction between year and volume suggests that the greatest IMRT% growth was in low volume centers (6.7% per year versus 4.3% per year for high volume). Conclusions: IMRT utilization has grown steadily across Michigan between 2005 and 2010. There is significant variation in its use that appears to be related in part to facility characteristics. The newly established Michigan Radiation Oncology Quality Collaborative (MROQC) is beginning to explore the use of IMRT in patients with breast and lung cancer statewide to identify those groups of patients where improved outcomes may justify its higher cost. [Table: see text]

A Low Volume Production Process Capability Analysis

2009 ◽  
Vol 16-19 ◽  
pp. 1038-1042
Author(s):  
Mark A. Harris ◽  
Diane J. Mynors ◽  
Chang J. Wang
Keyword(s):  
Data Gathering ◽  
Process Capability ◽  
High Volume ◽  
Machining Process ◽  
Statistical Process ◽  
Process Modification ◽  
Capability Indices ◽  
Capability Analysis ◽  
Before And After ◽  
Low Volume

Statistical Process Control (SPC) and Process Capability Indices (PCI) are used extensively within manufacturing and service environments. This paper reports the results of a statistical quality improvement programme when applied to a low volume, high gauge frequency machining process. The resultant capability indices (Cp and Cpk) are calculated from acquired data both before and after process modification, and are discussed in relation to the specific process. Box Cox data transformations are utilised in order to centralise data and the applicability of the capability improvements are determined. Historically SPC and capability analysis are performed on high volume processes with data being gathered on a sample basis. This investigation applies the high volume theory to a low volume 100% data gathering process. The validity of capability analysis of this nature is discussed due to long cycle times and large gauge inspection frequency.

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